Basic Information
| Provider Information | |||||||||
| NPI: | 1598948606 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COPLIN | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 37 FRIEND STREET | ||||||||
| Address2: | ELEMENT CARE INC | ||||||||
| City: | LYNN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817156608 | ||||||||
| FaxNumber: | 7817156699 | ||||||||
| Practice Location | |||||||||
| Address1: | 12 INGALLS COURT | ||||||||
| Address2: | ELEMENT CARE | ||||||||
| City: | METHUEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787220173 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 2023000 | MA | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 118399 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 118399 | 01 | MA | STATE LICENSE # | OTHER |