Provider Demographics
NPI:1316289721
Name:BOPP, KURT MICHAEL (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:KURT
Middle Name:MICHAEL
Last Name:BOPP
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 RUNYON AVE
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-4717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:295 PIERSON AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3118
Practice Address - Country:US
Practice Address - Phone:732-494-8558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-23
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055078001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical