Provider Demographics
NPI:1154146140
Name:COOPERSTONE, ROXANNE (CADC LLL BOO1771124)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:COOPERSTONE
Suffix:
Gender:F
Credentials:CADC LLL BOO1771124
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 N ORANGE GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-3315
Mailing Address - Country:US
Mailing Address - Phone:626-200-9971
Mailing Address - Fax:
Practice Address - Street 1:446 S MARENGO AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3113
Practice Address - Country:US
Practice Address - Phone:626-200-9971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)