Provider Demographics
NPI:1487486346
Name:KOPACH, JACOB CHRISTOPHER (MSW, LSW)
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:CHRISTOPHER
Last Name:KOPACH
Suffix:
Gender:M
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1167 MANTUA PIKE
Mailing Address - Street 2:
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08051-1649
Mailing Address - Country:US
Mailing Address - Phone:856-292-5760
Mailing Address - Fax:
Practice Address - Street 1:1167 MANTUA PIKE
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08051-1649
Practice Address - Country:US
Practice Address - Phone:856-292-5760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07174200104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker