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General NPI Number Information
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NPI Number | 1538832514
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Entity Type | Individual
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Provider Name | NICOLE KOPACZ
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Gender | Female
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Dates
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Enumeration Date | 07/27/2021
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Last Update Date | 09/21/2022
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Provider Practice Location Address
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Address Line | 235 HANOVER ST STE 5
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City | MANCHESTER
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State | NH
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Zip | 03104-6138
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Country | US
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Telephone | 603-505-8133
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Fax |
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Provider Business Mailing Address
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Address Line | 84 W BROADWAY STE 200
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City | DERRY
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State | NH
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Zip | 03038-2323
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Country | US
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Telephone | 603-505-8133
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 221574
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 124667
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2762
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License Number State | NH
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