Provider Demographics
NPI:1154329571
Name:COPEL, LINDA CARMAN (PHD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:CARMAN
Last Name:COPEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2256 GEORGETOWN DR
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-2308
Mailing Address - Country:US
Mailing Address - Phone:610-644-2171
Mailing Address - Fax:610-644-6597
Practice Address - Street 1:2256 GEORGETOWN DR
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-2308
Practice Address - Country:US
Practice Address - Phone:610-644-2171
Practice Address - Fax:610-644-6597
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-10
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN272213L101YM0800X, 103T00000X, 106H00000X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA07217851Medicaid
PA07217851Medicaid
PAR07383Medicare UPIN