Provider Demographics
NPI:1902100860
Name:COOPER, CYNTHIA (MSW)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 SW 48TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-6989
Mailing Address - Country:US
Mailing Address - Phone:239-322-4738
Mailing Address - Fax:239-543-5553
Practice Address - Street 1:1536 SW 48TH TER
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-6989
Practice Address - Country:US
Practice Address - Phone:239-322-4738
Practice Address - Fax:239-543-5553
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL001313800171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001313800Medicaid