Provider Demographics
NPI:1104815687
Name:HOOPER, CAROL (LCSW)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:HOOPER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 US 1 S
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-4205
Mailing Address - Country:US
Mailing Address - Phone:904-209-6009
Mailing Address - Fax:904-209-6002
Practice Address - Street 1:2120 US 1 S
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4205
Practice Address - Country:US
Practice Address - Phone:904-501-0846
Practice Address - Fax:904-217-7257
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2019-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2052106H00000X
FLSW58031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ029VOtherBCBS
FL070860700Medicaid
FLZ029VOtherBCBS
FLZ029VZMedicare ID - Type Unspecified