Provider Demographics
NPI:1831382142
Name:KOPS, KRISTINA ERICA (PSYD)
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:ERICA
Last Name:KOPS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PAMELA PL
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-3710
Mailing Address - Country:US
Mailing Address - Phone:203-226-6548
Mailing Address - Fax:203-227-6625
Practice Address - Street 1:11 PAMELA PL
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3710
Practice Address - Country:US
Practice Address - Phone:203-226-6548
Practice Address - Fax:203-227-6625
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2651103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical