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General NPI Number Information
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NPI Number | 1851561997
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Entity Type | Organization
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Legal Business Name | SHERIDAN LYNN KOPLOW ED D PA
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Dates
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Enumeration Date | 03/05/2008
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Last Update Date | 03/05/2008
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Provider Practice Location Address
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Address Line | 10111 W FOREST HILL BLVD SUITE 369
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City | WELLINGTON
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State | FL
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Zip | 33414-6108
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Country | US
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Telephone | 561-785-7767
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Fax | 561-784-4626
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Provider Business Mailing Address
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Address Line | 10111 W FOREST HILL BLVD SUITE 369
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City | WELLINGTON
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State | FL
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Zip | 33414-6108
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Country | US
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Telephone | 561-785-7767
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Fax | 561-784-4626
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Authorized Official
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Title or Position | PSYCHOLOGIST PRESIDENT
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Name | SHERIDAN LYNN KOPLOW
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Credential | ED D
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Telephone | 561-784-7767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PY6678
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License Number State | FL
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