MEDICARE: TAMAR A COOPER LISW

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
1	1041C0700X	Clinical Social Worker	I0005575	OH

General Provider Information

NPI Number	:	1265567457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMAR A COOPER LISW

Provider Business Mailing Address
First Line	:	15480 DURKEE RD
Second Line	:
City	:	HUNTSBURG
State	:	OH
Zip	:	44046-9733
Country	:	US
Telephone Number	:	440-739-0115
Fax Number	:

Provider Business Practice Location Address
First Line	:	11900 FAIRHILL RD
Second Line	:	SUITE 300
City	:	CLEVELAND
State	:	OH
Zip	:	44120-1062
Country	:	US
Telephone Number	:	216-373-1605
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	10/20/2010

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Directions to “ TAMAR A COOPER LISW” Practice Location

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