MEDICARE: BRIAN COOPER

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	SW13681	FL

General Provider Information

NPI Number	:	1285140186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN COOPER

Provider Business Mailing Address
First Line	:	510 DUXBURY CT APT A
Second Line	:
City	:	SAFETY HARBOR
State	:	FL
Zip	:	34695-4316
Country	:	US
Telephone Number	:	727-754-4936
Fax Number	:	866-496-4382

Provider Business Practice Location Address
First Line	:	510 DUXBURY CT APT A
Second Line	:
City	:	SAFETY HARBOR
State	:	FL
Zip	:	34695-4316
Country	:	US
Telephone Number	:	727-754-4936
Fax Number	:	866-496-4382

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

Provider Enumeration Date	:	12/15/2017
Last Update Date	:	12/15/2017

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Directions to “ BRIAN COOPER ” Practice Location

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