=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215815691
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AJA COUPAL KEPPLER LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2025
-----------------------------------------------------
Last Update Date | 08/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 58 OLD NORTH RD
-----------------------------------------------------
City | WORTHINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01098-9708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-238-5511
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 119 WAGON WHEEL DR
-----------------------------------------------------
City | FEEDING HILLS
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01030-1555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-855-0002
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | LCSW2141208
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------