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General NPI Number Information
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NPI Number | 1487193611
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Entity Type | Organization
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Legal Business Name | LISA COPPOLA
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Dates
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Enumeration Date | 02/21/2017
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | 406 MASSACHUSETTS AVE
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City | ARLINGTON
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State | MA
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Zip | 02474-6700
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Country | US
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Telephone | 603-571-0994
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Fax |
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Provider Business Mailing Address
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Address Line | 406 MASSACHUSETTS AVE
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City | ARLINGTON
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State | MA
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Zip | 02474-6700
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Country | US
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Telephone | 603-571-0994
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | LISA A COPPOLA
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Credential | LMHC
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Telephone | 603-571-0994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 10015
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License Number State | MA
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