Provider Demographics
NPI:1730705310
Name:COPELAND, JENNIFER ELIZABETH (MS, BCBA)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:COPELAND
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 WEDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FLOURTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19031-2128
Mailing Address - Country:US
Mailing Address - Phone:215-756-4904
Mailing Address - Fax:
Practice Address - Street 1:950 E HAVERFORD RD STE 100A
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3850
Practice Address - Country:US
Practice Address - Phone:215-515-8992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-06-3089103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty