Provider Demographics
NPI:1184318891
Name:KOPLITZ, LAUREN J (MS)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:J
Last Name:KOPLITZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 MILLROCK RD STOP 1
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1241
Mailing Address - Country:US
Mailing Address - Phone:631-896-2459
Mailing Address - Fax:
Practice Address - Street 1:726 E MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2654
Practice Address - Country:US
Practice Address - Phone:845-394-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist