Individual
MR. CHARLES J. COPPOLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
137 HAMMOND ST, PORT JERVIS, NY 12771-2608
(845) 858-8911
(845) 858-7911
Mailing address
137 HAMMOND ST, PORT JERVIS, NY 12771-2608
(845) 858-8911
(845) 858-7911
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
060301
NY
Other
Enumeration date
02/01/2007
Last updated
07/08/2007
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