Provider Demographics
NPI:1962073304
Name:COOPER, EARNESTINE
Entity type:Individual
Prefix:
First Name:EARNESTINE
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 668055
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33066-8055
Mailing Address - Country:US
Mailing Address - Phone:954-532-5196
Mailing Address - Fax:954-206-0697
Practice Address - Street 1:1951 W COPANS RD STE 8-14
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-1549
Practice Address - Country:US
Practice Address - Phone:954-532-5196
Practice Address - Fax:954-206-0697
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral