Provider Demographics
NPI:1215240395
Name:KOPPLE, KRISTIN (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:
Last Name:KOPPLE
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 1:1315 WALNUT ST STE 1700
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4717
Mailing Address - Country:US
Mailing Address - Phone:215-850-3490
Mailing Address - Fax:215-545-8496
Practice Address - Street 1:1315 WALNUT ST STE 1700
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4717
Practice Address - Country:US
Practice Address - Phone:215-850-3490
Practice Address - Fax:215-545-8496
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PAPS018288103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health