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General NPI Number Information
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NPI Number | 1336788488
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Entity Type | Organization
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Legal Business Name | KELLY COPELAND PSYD LLC
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Dates
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Enumeration Date | 01/06/2020
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Last Update Date | 01/06/2020
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Provider Practice Location Address
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Address Line | 1200 HIGH RIDGE RD STE 208
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City | STAMFORD
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State | CT
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Zip | 06905-1202
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Country | US
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Telephone | 203-539-1033
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Fax |
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Provider Business Mailing Address
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Address Line | 36 RIDGE BROOK LN
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City | STAMFORD
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State | CT
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Zip | 06903-1239
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Country | US
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Telephone | 585-245-3900
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | KELLY COPELAND
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Credential | PSYD
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Telephone | 585-245-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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