Provider Demographics
NPI:1104945419
Name:COPPERSMITH, WILLIAM CARLTON JR (MA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CARLTON
Last Name:COPPERSMITH
Suffix:JR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-1824
Mailing Address - Country:US
Mailing Address - Phone:303-441-1136
Mailing Address - Fax:303-441-1286
Practice Address - Street 1:3450 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-1824
Practice Address - Country:US
Practice Address - Phone:303-441-1136
Practice Address - Fax:303-441-1286
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health