Healthcare Provider Details

I. General information

NPI: 1154014835
Provider Name (Legal Business Name): GRADY MICHAEL COOPER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 CLAIRTON BLVD SUITE 500/600
PITTSBURGH PA
15236-5505
US

IV. Provider business mailing address

810 CLAIRTON BLVD STE 500600
PITTSBURGH PA
15236-5505
US

V. Phone/Fax

Practice location:
  • Phone: 412-650-1100
  • Fax: 412-650-1101
Mailing address:
  • Phone: 412-650-1100
  • Fax: 412-650-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW026617
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: