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General NPI Number Information
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NPI Number | 1447794441
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Entity Type | Individual
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Provider Name | NICHOLAS C KOPAZNA LPC
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Gender | Male
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Dates
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Enumeration Date | 12/09/2016
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Last Update Date | 05/23/2018
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Provider Practice Location Address
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Address Line | 433 MEADOW ST
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City | FAIRFIELD
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State | CT
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Zip | 06824
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Country | US
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Telephone | 203-913-3560
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Fax |
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Provider Business Mailing Address
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Address Line | 605 WASHINGTON AVE
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City | NORTH HAVEN
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State | CT
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Zip | 06473-1123
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Country | US
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Telephone | 203-864-9070
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 3070
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License Number State | CT
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