=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265567457
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMAR A COOPER LISW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2007
-----------------------------------------------------
Last Update Date | 10/20/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11900 FAIRHILL RD SUITE 300
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44120-1062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-373-1605
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15480 DURKEE RD
-----------------------------------------------------
City | HUNTSBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44046-9733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-739-0115
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | I0005575
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------