Provider Demographics
NPI:1023308004
Name:KOPCSIK, CHRYSTINE PATRICIA (LCSW)
Entity type:Individual
Prefix:
First Name:CHRYSTINE
Middle Name:PATRICIA
Last Name:KOPCSIK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-2706
Mailing Address - Country:US
Mailing Address - Phone:305-514-8524
Mailing Address - Fax:305-762-1489
Practice Address - Street 1:5200 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-2706
Practice Address - Country:US
Practice Address - Phone:305-514-8524
Practice Address - Fax:305-762-1489
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW101241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical