Provider Demographics
NPI:1194325134
Name:COPELAND-CLARKE, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:COPELAND-CLARKE
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 1:19 ENDICOTT ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7821
Mailing Address - Country:US
Mailing Address - Phone:781-315-3419
Mailing Address - Fax:
Practice Address - Street 1:19 ENDICOTT ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7821
Practice Address - Country:US
Practice Address - Phone:781-315-3419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician