Individual
DOMINIQUE COPPOLINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
591 LAKEHURST RD, TOMS RIVER, NJ 08755-8045
(732) 367-1710
Mailing address
PREFERRED BEHAVIORAL HEALTH GROUP PO BOX 2036, LAKEWOOD, NJ 08701-1541
(732) 367-1710
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
44SC05837100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0029807
NJ
—
Enumeration date
01/11/2019
Last updated
01/11/2019
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