Jennifer Lauren Coppola, PH.D., LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

001637 Issued in NY

Practice address

4500 Pewter LN # 89
Manlius, NY 13104-9707

Phone

(315) 414-9743

NPI assigned

Feb 8, 2020

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 8, 2020.

{
    "created_epoch": "1581120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581120000000",
    "number": "1164054060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4641 PAULI DR",
            "city": "MANLIUS",
            "state": "NY",
            "postal_code": "131042419",
            "telephone_number": "585-732-8852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 PEWTER LN # 89",
            "city": "MANLIUS",
            "state": "NY",
            "postal_code": "131049707",
            "telephone_number": "315-414-9743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COPPOLA",
        "first_name": "JENNIFER",
        "middle_name": "LAUREN",
        "name_prefix": "Dr.",
        "credential": "PH.D., LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-08",
        "last_updated": "2020-02-08",
        "certification_date": "2020-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NY",
            "license": "001637",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Manlius, NY
• Marriage & Family Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.