Raymond J Coppola, PH.D

Primary specialty

PsychologistTaxonomy code 103T00000X

License

022676 Issued in NY

Practice address

1 Marcus Blvd Ste 106
Albany, NY 12205-5953

Phone

(774) 318-0850

NPI assigned

Feb 27, 2009

Reactivated

Jun 14, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 4

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 Psychologist

Education

Other, 2014

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Christine a Marra Psychologist PLLC

  • Clinical Psychologist
  • Albany, NY
  • NPI 1851636104
  NPD (past)
• Spectrum Health Systems, Inc

  • Community/Behavioral Health Agency
  • Worcester, MA
  • NPI 1346430253
  NPD (past)

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

{
    "created_epoch": "1235692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551225600000",
    "number": "1598905770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 4TH AVE",
            "city": "TROY",
            "state": "NY",
            "postal_code": "121822513",
            "telephone_number": "774-318-0850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MARCUS BLVD STE 106",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122055953",
            "telephone_number": "774-318-0850"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "585 Lincoln St",
            "address_purpose": "LOCATION",
            "city": "Worcester",
            "state": "MA",
            "postal_code": "016051906",
            "country_code": "US",
            "telephone_number": "508-831-0045",
            "fax_number": "508-753-5051",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "415 Main St",
            "address_purpose": "LOCATION",
            "city": "Ridgefield",
            "state": "CT",
            "postal_code": "068774500",
            "country_code": "US",
            "telephone_number": "203-438-7565",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COPPOLA",
        "first_name": "RAYMOND",
        "middle_name": "J",
        "credential": "PH.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-02-27",
        "last_updated": "2019-02-27",
        "deactivation_date": "2018-06-04",
        "reactivation_date": "2018-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "022676",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "M18684",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "2220002001",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306421",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1308785",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taylor Cooper
• Bruce E. Coplin, M.D.
• Tanisha A Coppin, LMSW
• Carol L Coppola, LCSW-R
• Laurie L Coppola, FNP-C
• Laura Coppolo, RPH
• Coram Healthcare Corporation of Greater New York
• Coram Healthcare Corporation of New York
• Jennifer Corazzini, SLP
• Dennis Francis Corbett, M.D.

• Psychologist in Albany, NY
• Providers in Albany, NY by specialty
• Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2019; 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.