Provider Demographics
NPI:1093985533
Name:DEPAIVA, FLORA COOPER (LICSW)
Entity Type:Individual
Prefix:MS
First Name:FLORA
Middle Name:COOPER
Last Name:DEPAIVA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:492 WALTHAM ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-1920
Mailing Address - Country:US
Mailing Address - Phone:617-969-5906
Mailing Address - Fax:
Practice Address - Street 1:492 WALTHAM ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02465
Practice Address - Country:US
Practice Address - Phone:617-969-5906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1152161041C0700X
MA2143091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical