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General NPI Number Information
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NPI Number | 1689555211
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Entity Type | Individual
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Provider Name | MELISSA COPELAND PH.D.
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Gender | Female
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Dates
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Enumeration Date | 09/10/2025
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 4161 TAMIAMI TRL
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-9204
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Country | US
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Telephone | 941-235-2710
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Fax |
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Provider Business Mailing Address
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Address Line | 9 CHAD MICHAEL CT
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City | BLACKSTONE
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State | MA
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Zip | 01504-1238
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Country | US
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Telephone | 774-287-8141
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY10001266
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License Number State | MA
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