Provider Demographics
NPI:1427650928
Name:KOPRONICA, JUSTIN (BA, CT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:KOPRONICA
Suffix:
Gender:M
Credentials:BA, CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4643 SWIFT CT
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-7564
Mailing Address - Country:US
Mailing Address - Phone:937-239-7973
Mailing Address - Fax:
Practice Address - Street 1:8809 CINCINNATI DAYTON RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-3134
Practice Address - Country:US
Practice Address - Phone:513-360-8205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2405830101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health