Provider Demographics
NPI:1992875686
Name:KOPIT, PHYLLIS (LCSW)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:KOPIT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20H HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-7916
Mailing Address - Country:US
Mailing Address - Phone:973-868-7063
Mailing Address - Fax:
Practice Address - Street 1:20 COMMUNITY PL
Practice Address - Street 2:SUITE 400
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7500
Practice Address - Country:US
Practice Address - Phone:973-868-7063
Practice Address - Fax:973-539-3687
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC045481001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical