Provider Demographics
NPI:1861553091
Name:KOPP WIENER, RONNIE (PHD)
Entity type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:
Last Name:KOPP WIENER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:RONNIE
Other - Middle Name:GOLDSTEIN
Other - Last Name:KOPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8204 POLK DRIVE
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07885-4202
Mailing Address - Country:US
Mailing Address - Phone:973-586-3022
Mailing Address - Fax:
Practice Address - Street 1:8204 POLK DRIVE
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:NJ
Practice Address - Zip Code:07885-4202
Practice Address - Country:US
Practice Address - Phone:973-586-3022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FI00121100106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist