MEDICARE: MR. RONALD EDWARD COOPER LICSW

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	LC302264	DC

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	:	1700075306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD EDWARD COOPER LICSW

Provider Business Mailing Address
First Line	:	202 WARREN ST NE
Second Line	:	APT. #3
City	:	WASHINGTON
State	:	DC
Zip	:	20002-6476
Country	:	US
Telephone Number	:	202-486-3501
Fax Number	:

Provider Business Practice Location Address
First Line	:	6856 EASTERN AVE NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20012-2165
Country	:	US
Telephone Number	:	202-723-6600
Fax Number	:	202-723-2549

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

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	07/14/2011

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