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General NPI Number Information
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NPI Number | 1891092557
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Entity Type | Individual
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Provider Name | SUZANNE O'SULLIVAN COOPER LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/16/2011
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Last Update Date | 02/16/2011
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Provider Practice Location Address
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Address Line | 10535 HOSPITAL WAY
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City | MATHER
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State | CA
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Zip | 95655-4200
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Country | US
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Telephone | 707-364-1615
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Fax |
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Provider Business Mailing Address
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Address Line | 2935 COLOMA ST
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City | PLACERVILLE
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State | CA
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Zip | 95667-4435
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Country | US
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Telephone | 707-364-1615
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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 | LCS25967
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License Number State | CA
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