MEDICARE: MS. DIANE SCOTLAND-COOGAN MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1013213966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANE SCOTLAND-COOGAN MSW

Provider Business Mailing Address
First Line	:	12709 RIDGEVIEW CT
Second Line	:
City	:	DADE CITY
State	:	FL
Zip	:	33525-6221
Country	:	US
Telephone Number	:	352-238-6126
Fax Number	:

Provider Business Practice Location Address
First Line	:	12709 RIDGEVIEW CT
Second Line	:
City	:	DADE CITY
State	:	FL
Zip	:	33525-6221
Country	:	US
Telephone Number	:	352-238-6126
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2011
Last Update Date	:	02/09/2011

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