Individual ProviderWillow Vivian CopulosSpeech-Language PathologistSpeech, Language and Hearing Service ProvidersPractice Address1415 Richmond Ave, Staten Island, NY 10314-1553(877) 407-3422PECOS EnrollmentBased on the most recent information from CMS, provider Willow Vivian Copulos does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1679458657Provider TypeIndividualFull NameCopulos, Willow VivianGenderFemaleSole ProprietorNoEnumeration Date8/8/2025Last Updated8/8/2025Contact InformationPractice LocationPractice Address1415 Richmond Ave, Staten Island, NY 10314-1553Phone(877) 407-3422Fax(877) 407-4329Mailing LocationMailing Address7 Carnegie Plz, Cherry Hill, NJ 08003-1000Phone(877) 407-3422Fax(877) 407-4329Provider TaxonomiesCodeDescriptionLicenseCode235Z00000XPrimaryDescriptionSpeech-Language PathologistSpeech, Language and Hearing Service ProvidersLicense033852New York