Provider Demographics
NPI:1902156425
Name:COPPERMAN, ANDREW (LMFT 82005)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:COPPERMAN
Suffix:
Gender:M
Credentials:LMFT 82005
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 SIR FRANCIS DRAKE #5
Mailing Address - Street 2:
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904
Mailing Address - Country:US
Mailing Address - Phone:415-847-8842
Mailing Address - Fax:
Practice Address - Street 1:240 TAMAL VISTA BLVD STE 290
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1159
Practice Address - Country:US
Practice Address - Phone:415-847-8842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82005106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist