Provider Demographics
NPI:1427668706
Name:COPPOLA, SAMANTHA JOAN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:JOAN
Last Name:COPPOLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:JOAN
Other - Last Name:BODAMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3220 BROOK RD APT 203
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-4850
Mailing Address - Country:US
Mailing Address - Phone:814-558-3989
Mailing Address - Fax:
Practice Address - Street 1:3220 BROOK RD APT 203
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-4850
Practice Address - Country:US
Practice Address - Phone:814-558-3989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0206081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical