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NPI Code Detail

MEDICARE: MRS. ALICIA JUDITH COOPER BS

MEDICARE: MRS. ALICIA JUDITH COOPER BS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker

General Provider Information

NPI Number : 1003990789
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ALICIA JUDITH COOPER BS
Provider Business Mailing Address
First Line : 3333 W 20TH ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32254-1703
Country : US
Telephone Number : 904-695-0033
Fax Number : 904-695-3324
Provider Business Practice Location Address
First Line : 3333 W 20TH ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32254-1703
Country : US
Telephone Number : 904-695-0033
Fax Number : 904-695-3324
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2006
Last Update Date : 07/09/2007

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