Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | LCSW-0744 | AZ |
NPI | 1003186297 |
---|---|
Provider Name | Mr. Ronald Edward Copeland |
First Address | Tucson, AZ 85750-7046 |
Second Address | Tucson, AZ 85712-3437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2012 |
Last Update Date | 05/01/2012 |