Provider Demographics
NPI:1184920134
Name:SUSAN T. COPPETO LCSW PC
Entity type:Organization
Organization Name:SUSAN T. COPPETO LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:COPPETO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW PC
Authorized Official - Phone:631-567-6721
Mailing Address - Street 1:68 CANNON DR
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-5219
Mailing Address - Country:US
Mailing Address - Phone:631-567-6721
Mailing Address - Fax:
Practice Address - Street 1:68 CANNON DR.
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741
Practice Address - Country:US
Practice Address - Phone:631-567-6721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR051696-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty