=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457521536
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHESTER D. COPEMANN PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2008
-----------------------------------------------------
Last Update Date | 03/05/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | #34 ALDERSVILLE
-----------------------------------------------------
City | CHRISTIANSTED
-----------------------------------------------------
State | VI
-----------------------------------------------------
Zip | 00820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 340-773-5113
-----------------------------------------------------
Fax | 340-773-5163
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1547
-----------------------------------------------------
City | KINGSHILL
-----------------------------------------------------
State | VI
-----------------------------------------------------
Zip | 00851-1547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 340-773-5113
-----------------------------------------------------
Fax | 340-773-5163
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TB0200X
-----------------------------------------------------
Taxonomy Name | Cognitive & Behavioral Psychologist
-----------------------------------------------------
License Number | 02-014-PSY
-----------------------------------------------------
License Number State | VI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 02-014-PSY
-----------------------------------------------------
License Number State | VI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 103TC2200X
-----------------------------------------------------
Taxonomy Name | Clinical Child & Adolescent Psychologist
-----------------------------------------------------
License Number | 02-014-PSY
-----------------------------------------------------
License Number State | VI
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 103TF0200X
-----------------------------------------------------
Taxonomy Name | Forensic Psychologist
-----------------------------------------------------
License Number | 02-014-PSY
-----------------------------------------------------
License Number State | VI
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 103TH0004X
-----------------------------------------------------
Taxonomy Name | Health Psychologist
-----------------------------------------------------
License Number | 02-014-PSY
-----------------------------------------------------
License Number State | VI
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 103TR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Psychologist
-----------------------------------------------------
License Number | 02-014-PSY
-----------------------------------------------------
License Number State | VI
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number | 02-014-PSY
-----------------------------------------------------
License Number State | VI
-----------------------------------------------------