Active NPI
Kim Coppola, LCSW, MSW
- Clinical Social Worker
- Frederick, MD
National Provider Identifier
1861869315
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 24174
- Practice address
- 5301 Buckeystown Pike Ste 480J
Frederick, MD 21704-8379 - Phone
- (240) 397-8380
- NPI assigned
- Aug 31, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 44SL06112300 | NJ | |
| Clinical Social Worker | 1041C0700X | 24174 | MD | Primary |
Addresses
Primary practice location
5301 Buckeystown Pike Ste 480J
Frederick, MD 21704-8379
Mailing address
810 Toll House Ave
Frederick, MD 21701-4519
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 44SL06112300 | NJ | MD | Social Worker |
| 24174 | MD | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1440979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1737331200000",
"number": "1861869315",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "810 TOLL HOUSE AVE",
"city": "FREDERICK",
"state": "MD",
"postal_code": "217014519"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5301 BUCKEYSTOWN PIKE STE 480J",
"city": "FREDERICK",
"state": "MD",
"postal_code": "217048379",
"telephone_number": "240-397-8380"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COPPOLA",
"first_name": "KIM",
"credential": "LCSW, MSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-08-31",
"last_updated": "2025-01-20",
"certification_date": "2025-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NJ",
"license": "44SL06112300",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MD",
"license": "24174",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Frederick, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.