Provider Demographics
NPI:1194212415
Name:COOPER, ROBIN (LCSW, M ED)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:LCSW, M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4203 RANSTEAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3008
Mailing Address - Country:US
Mailing Address - Phone:267-571-5381
Mailing Address - Fax:
Practice Address - Street 1:4203 RANSTEAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3008
Practice Address - Country:US
Practice Address - Phone:267-571-5381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0198911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical