Provider Demographics
NPI:1942370242
Name:COPPOLA, NICHOLAS (LCSW)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:
Last Name:COPPOLA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 HILLSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-6412
Mailing Address - Country:US
Mailing Address - Phone:846-338-5682
Mailing Address - Fax:845-338-5682
Practice Address - Street 1:560 STATE ROUTE 299
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-2841
Practice Address - Country:US
Practice Address - Phone:845-883-9747
Practice Address - Fax:845-883-9751
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR019110-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN24421Medicare ID - Type Unspecified