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General NPI Number Information
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NPI Number | 1558020461
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Entity Type | Individual
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Provider Name | CRYSTAL KIM COPELAND LMSW
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Gender | Female
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Dates
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Enumeration Date | 12/08/2021
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Last Update Date | 12/08/2021
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Provider Practice Location Address
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Address Line | 8658 AITKEN AVE
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City | WHITESBORO
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State | NY
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Zip | 13492-2609
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Country | US
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Telephone | 315-570-5187
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Fax |
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Provider Business Mailing Address
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Address Line | 1026 ONTARIO ST
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City | UTICA
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State | NY
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Zip | 13501-2744
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Country | US
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Telephone | 315-570-5187
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 109837-01
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License Number State | NY
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