MEDICARE: LAURA ELIZABETH COOPER LCSW

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	258552	KY

General Provider Information

NPI Number	:	1417498106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ELIZABETH COOPER LCSW

Provider Business Mailing Address
First Line	:	1351 NEWTOWN PIKE
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40511-1275
Country	:	US
Telephone Number	:	859-253-1686
Fax Number	:	859-254-2743

Provider Business Practice Location Address
First Line	:	600 MONTICELLO ST STE 2
Second Line	:
City	:	SOMERSET
State	:	KY
Zip	:	42501-2974
Country	:	US
Telephone Number	:	606-401-2966
Fax Number	:	606-244-4111

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

Provider Enumeration Date	:	03/14/2017
Last Update Date	:	03/31/2025

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