Healthcare Provider Details

I. General information

NPI: 1326569096
Provider Name (Legal Business Name): SARAH ELISE COOPER LCSW, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1753 RINGLING BLVD
SARASOTA FL
34236-6874
US

IV. Provider business mailing address

2688 FRUITVILLE RD
SARASOTA FL
34237-5223
US

V. Phone/Fax

Practice location:
  • Phone: 941-366-2224
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14609
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: