Organization
MINDY S KOPOLOW PSYD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MINDY SUE KOPOLOW MA, PSYD (PRESIDENT)
(617) 972-5055
Entity
Organization
Contact information
Practice address
400 W CUMMINGS PARK, SUITE 3400, WOBURN, MA 01801-6519
(617) 972-5055
(617) 972-5011
Mailing address
400 W CUMMINGS PARK, SUITE 3400, WOBURN, MA 01801-6519
(617) 972-5055
(617) 972-5011
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
851
MA
103TC0700X
Clinical Psychologist
Primary
8603
MA
103TC0700X
Clinical Psychologist
PY5819
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
54439
BLUE CROSS BLUE SHIELD
FL
Enumeration date
03/30/2007
Last updated
04/04/2013
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