Healthcare Provider Details

I. General information

NPI: 1073617155
Provider Name (Legal Business Name): COPE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 PINEHAVEN DR
MARY ESTHER FL
32569-3323
US

IV. Provider business mailing address

103 PINEHAVEN DR
MARY ESTHER FL
32569-3323
US

V. Phone/Fax

Practice location:
  • Phone: 850-218-3532
  • Fax:
Mailing address:
  • Phone: 850-218-3532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW 3621
License Number StateFL

VIII. Authorized Official

Name: MS. CHERYL ANN STULZAFT
Title or Position: COMPREHENSIVE ASSESSOR
Credential:
Phone: 850-218-3532