Provider Demographics
NPI:1154014835
Name:COOPER, GRADY MICHAEL
Entity type:Individual
Prefix:
First Name:GRADY
Middle Name:MICHAEL
Last Name:COOPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 PEEBLES ST APT 1
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-2777
Mailing Address - Country:US
Mailing Address - Phone:301-787-1079
Mailing Address - Fax:
Practice Address - Street 1:810 CLAIRTON BLVD STE 500
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-5511
Practice Address - Country:US
Practice Address - Phone:412-881-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker