MEDICARE: MR. JOHN NATHANIEL COPELAND MA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1780704395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN NATHANIEL COPELAND MA

Provider Business Mailing Address
First Line	:	54 PALFREY ST
Second Line	:	1
City	:	WATERTOWN
State	:	MA
Zip	:	02472-4702
Country	:	US
Telephone Number	:	413-822-9256
Fax Number	:

Provider Business Practice Location Address
First Line	:	1419 HANCOCK ST
Second Line	:	STE. 201
City	:	QUINCY
State	:	MA
Zip	:	02169-5250
Country	:	US
Telephone Number	:	617-328-0639
Fax Number	:

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	02/22/2017

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