Provider Demographics
NPI:1427812254
Name:KOPSOVICH, MARY ELIZABETH (LMSW)
Entity type:Individual
Prefix:
First Name:MARY ELIZABETH
Middle Name:
Last Name:KOPSOVICH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 DARTMOUTH DR SE APT D
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2261
Mailing Address - Country:US
Mailing Address - Phone:505-333-9042
Mailing Address - Fax:505-796-5475
Practice Address - Street 1:120 DARTMOUTH DR SE APT D
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2261
Practice Address - Country:US
Practice Address - Phone:505-333-9042
Practice Address - Fax:505-796-5475
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59040104100000X
NMSWB-2024-0152104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker