MEDICARE: DR. STEFANIE J COPPES PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	PY 8604	FL
2	103TB0200X	Cognitive & Behavioral Psychologist	PY 8604	FL
3	103TC0700X	Clinical Psychologist	PY 8604	FL
4	103TC1900X	Counseling Psychologist	PY 8604	FL
5	103TC2200X	Clinical Child & Adolescent Psychologist	PY 8604	FL
6	103TE1100X	Exercise & Sports Psychologist	PY 8604	FL
7	103TF0000X	Family Psychologist	PY 8604	FL
8	103TM1800X	Intellectual & Developmental Disabilities Psychologist	PY 8604	FL
9	103TS0200X	School Psychologist	PY 8604	FL
10	103T00000X	Psychologist	PY 8604	FL

General Provider Information

NPI Number	:	1093065807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEFANIE J COPPES PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 8
Second Line	:
City	:	TERRA CEIA
State	:	FL
Zip	:	34250-0008
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 GULF TO BAY BLVD STE 300
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33759-4304
Country	:	US
Telephone Number	:	800-687-1938
Fax Number	:	727-495-7233

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2012
Last Update Date	:	01/03/2023

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