Marisa Kopa, LMSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

110334-01 Issued in NY

Practice address

15 Fortune Rd W
Middletown, NY 10941-1625

Phone

(845) 343-5556

Fax

(845) 343-3341

NPI assigned

Oct 19, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Access Supports for Living IncGroup PAC ID 8729992730, 41 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Access: Supports for Living Inc

  • Multi-Specialty Clinic/Center
  • Middletown, NY
  • NPI 1528174976
  Medicare reassignment Care Compare group NPD
• Access: Supports for Living Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Middletown, NY
  • NPI 1790326320
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642982400000",
    "number": "1376142653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 FORTUNE RD W",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109411625",
            "telephone_number": "845-343-5556",
            "fax_number": "845-343-3341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 FORTUNE RD W",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109411625",
            "telephone_number": "845-343-5556",
            "fax_number": "845-343-3341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOPA",
        "first_name": "MARISA",
        "name_prefix": "Ms.",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-19",
        "last_updated": "2022-01-24",
        "certification_date": "2021-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "110334-01",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNKNOWN",
            "identifier": "UNKNOWN",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Unknown",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Unknown",
            "address_1": "16-24 Union Street",
            "city": "Middletown",
            "state": "NY",
            "country_code": "US",
            "postal_code": "10940",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Karen Ruth Kolster, MS SPEC ED.
• Gnanamba V Kondagunta, MD
• Fanhong Kong
• Christopher Konitz, LMHC, RN
• Ronald Harmon Konowitz, PH.D.
• Lauren J Koplitz, M.S.
• Kantaya Korsak
• Melissa Anne Kostic, COTA
• Kirankumar Kantilal Kothari, MD
• Carmen Kotry, PA-C

• Mental Health Counselor in Middletown, NY
• Providers in Middletown, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.