Provider Demographics
NPI:1699517136
Name:COOPER-MEEGAN, SAMARIA B (LSW)
Entity type:Individual
Prefix:
First Name:SAMARIA
Middle Name:B
Last Name:COOPER-MEEGAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:SAMARIA
Other - Middle Name:B
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 SIBLEY ST APT 633
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2936
Mailing Address - Country:US
Mailing Address - Phone:763-393-7881
Mailing Address - Fax:
Practice Address - Street 1:401 SIBLEY ST APT 633
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2936
Practice Address - Country:US
Practice Address - Phone:763-393-7881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN14564104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker