Provider Demographics
NPI:1336206739
Name:KOPETSKIE, STEPHEN (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:KOPETSKIE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5692 BENTGRASS DR
Mailing Address - Street 2:#211
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34235-7641
Mailing Address - Country:US
Mailing Address - Phone:941-341-0772
Mailing Address - Fax:
Practice Address - Street 1:1750 17TH ST
Practice Address - Street 2:BUILDING C
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-8632
Practice Address - Country:US
Practice Address - Phone:941-953-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7095103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical