Provider Demographics
NPI:1033397096
Name:COOPER, CONSTANCE (LCSW)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 HIAWATHA ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-5958
Mailing Address - Country:US
Mailing Address - Phone:904-233-8690
Mailing Address - Fax:904-448-0349
Practice Address - Street 1:6261 DUPONT STATION CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2567
Practice Address - Country:US
Practice Address - Phone:904-394-5761
Practice Address - Fax:904-448-0349
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW89011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical