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General NPI Number Information
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NPI Number | 1457853434
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Entity Type | Individual
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Provider Name | PATRICK KOPEC CASAC-T
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Gender | Male
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Dates
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Enumeration Date | 03/06/2018
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Last Update Date | 03/06/2018
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Provider Practice Location Address
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Address Line | 57 SAINT MARKS PL
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City | NEW YORK
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State | NY
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Zip | 10003-7902
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Country | US
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Telephone | 212-533-0570
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Fax |
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Provider Business Mailing Address
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Address Line | 373 GANSEVOORT BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10314-5116
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Country | US
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Telephone | 347-284-8624
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 34254
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License Number State | NY
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