Provider Demographics
NPI:1164609251
Name:KOERPER, JOAN (LCSW)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:
Last Name:KOERPER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:DR
Other - First Name:MARY JOAN
Other - Middle Name:
Other - Last Name:KOERPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:3859 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-2445
Mailing Address - Country:US
Mailing Address - Phone:951-334-6862
Mailing Address - Fax:
Practice Address - Street 1:3859 RIDGE RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-2445
Practice Address - Country:US
Practice Address - Phone:951-334-6862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS123381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical