Dominique Coppolino, MSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

44SC05837100 Issued in NJ

Practice address

591 Lakehurst Rd
Toms River, NJ 08755-8045

Phone

(732) 367-1710

NPI assigned

Jan 11, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1547164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547164800000",
    "number": "1487128526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PREFERRED BEHAVIORAL HEALTH GROUP PO BOX 2036",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087011541",
            "telephone_number": "732-367-1710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "591 LAKEHURST RD",
            "city": "TOMS RIVER",
            "state": "NJ",
            "postal_code": "087558045",
            "telephone_number": "732-367-1710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COPPOLINO",
        "first_name": "DOMINIQUE",
        "credential": "MSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-11",
        "last_updated": "2019-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC05837100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NJ",
            "identifier": "0029807",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gary M Cookson, P.T.
• Jennifer M Cooper, LCSW
• Bruce William Cooperman, DPM
• Bruce Coplin, M.D.
• Victoria Coppola, PA-C
• Gregory Joseph Coram, PSY.D. & APN-BC
• Richelle Corbo, LPC
• Russell John Cornell, M.D.
• Cornerstone Medical and Surgical Associates L.L.C.
• Elaine Corona, LCSW

• Clinical Social Worker in Toms River, NJ
• Providers in Toms River, NJ by specialty
• Clinical Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2019; 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.