Provider Demographics
NPI:1891014981
Name:KOPSTEIN, ILENE (PHD)
Entity type:Individual
Prefix:DR
First Name:ILENE
Middle Name:
Last Name:KOPSTEIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:ILENE
Other - Middle Name:
Other - Last Name:ROSENBLUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:695 DICKENS AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-3323
Mailing Address - Country:US
Mailing Address - Phone:516-477-8769
Mailing Address - Fax:
Practice Address - Street 1:695 DICKENS AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-3323
Practice Address - Country:US
Practice Address - Phone:516-477-8769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016638103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool