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General NPI Number Information
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NPI Number | 1386246965
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Entity Type | Individual
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Provider Name | RICHARD SOPER LCSW
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Gender | Male
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Dates
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Enumeration Date | 11/10/2020
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Last Update Date | 06/20/2023
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Provider Practice Location Address
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Address Line | 7901 4TH ST N
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City | ST PETERSBURG
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State | FL
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Zip | 33702-4305
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Country | US
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Telephone | 407-506-3612
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Fax |
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Provider Business Mailing Address
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Address Line | 242 NE BRAMBLE ST
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City | WINSTON
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State | OR
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Zip | 97496-6610
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Country | US
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Telephone | 407-506-3612
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | SW17976
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW007597
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License Number State | GA
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