Provider Demographics
NPI:1093351371
Name:COPPOLINO, FARRAH CLARE
Entity type:Individual
Prefix:
First Name:FARRAH
Middle Name:CLARE
Last Name:COPPOLINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SMITHFIELD CT
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2777
Mailing Address - Country:US
Mailing Address - Phone:908-907-6323
Mailing Address - Fax:
Practice Address - Street 1:418 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2521
Practice Address - Country:US
Practice Address - Phone:888-261-1110
Practice Address - Fax:732-204-1636
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NJ1-24-76296103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician