Joseph Coppolo Jr., PSY.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

010359 Issued in NY

Practice address

3 William Ave
Staten Island, NY 10308-3142

Phone

(718) 667-3790

Fax

(718) 667-3790

NPI assigned

Dec 6, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jul 1, 2018 through Jul 1, 2028

Medicare enrollment (NPD)

Enrolled

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.

• Welllife Network Inc.

  • Case Management Agency
  • Coram, NY
  • NPI 1386817906
  NPD (past)
• Associates in Family Psychology

  • Clinical Psychologist
  • Fort Myers, FL
  • NPI 1275712911
  NPD (past)
• Pooja Shastri, Psy.D., P.a.

  • Clinical Psychologist
  • Fort Myers, FL
  • NPI 1891334157
  NPD (past)

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

{
    "created_epoch": "1196899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196899200000",
    "number": "1619150299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 WILLIAM AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103083142",
            "telephone_number": "718-667-3790",
            "fax_number": "718-667-3790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 WILLIAM AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103083142",
            "telephone_number": "718-667-3790",
            "fax_number": "718-667-3790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COPPOLO",
        "first_name": "JOSEPH",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "PSY.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-12-06",
        "last_updated": "2007-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "010359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin Coppa, M.A., CCC-SLP
• Laura Coppa, R.N
• Amanda Coppola
• Daniella Coppola
• Vanessa Coppola
• Willow Vivian Copulos
• Yenny Rocio Coral, OTR/L
• Laurene Marie Corbino, CNM
• Jeremiah Michael Corbo, LMHC
• Karen Melissa Corbo

• Clinical Psychologist in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.