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General NPI Number Information
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NPI Number | 1245743871
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Entity Type | Individual
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Provider Name | ELIZABETH COOPER
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Gender | Female
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Dates
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Enumeration Date | 11/06/2017
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Last Update Date | 11/06/2017
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Provider Practice Location Address
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Address Line | 780 AMERICAN LEGION HWY
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City | ROSLINDALE
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State | MA
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Zip | 02131-3908
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Country | US
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Telephone | 857-331-0169
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Fax |
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Provider Business Mailing Address
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Address Line | 37 SAINT GERMAIN ST APT 4
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City | BOSTON
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State | MA
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Zip | 02115-3227
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Country | US
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Telephone | 603-996-1319
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 119343
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License Number State | MA
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