MEDICARE: COPE CENTER, INC

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	ISW 3621	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073617155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COPE CENTER, INC

Provider Business Mailing Address
First Line	:	103 PINEHAVEN DR
Second Line	:
City	:	MARY ESTHER
State	:	FL
Zip	:	32569-3323
Country	:	US
Telephone Number	:	850-218-3532
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 PINEHAVEN DR
Second Line	:
City	:	MARY ESTHER
State	:	FL
Zip	:	32569-3323
Country	:	US
Telephone Number	:	850-218-3532
Fax Number	:

Authorized Official
Title or Position	:	COMPREHENSIVE ASSESSOR
Name	:	MS. CHERYL ANN STULZAFT
Credential	:
Telephone Number	:	850-218-3532

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	08/08/2008

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Directions to “COPE CENTER, INC ” Practice Location

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