Provider Demographics
NPI:1477616969
Name:CECILE J COOPER MSW LCSW A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:CECILE J COOPER MSW LCSW A PROFESSIONAL CORP
Other - Org Name:CELE COOPER
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYCHOTHERAPIST PRIVATE PRACTICE
Authorized Official - Prefix:MS
Authorized Official - First Name:CECILE
Authorized Official - Middle Name:J
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:818-990-2356
Mailing Address - Street 1:16255 VENTURA BL #806
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2317
Mailing Address - Country:US
Mailing Address - Phone:818-990-2356
Mailing Address - Fax:818-990-2356
Practice Address - Street 1:16255 VENTURA BL #806
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2317
Practice Address - Country:US
Practice Address - Phone:818-990-2356
Practice Address - Fax:818-990-2356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW437Medicare ID - Type Unspecified
CAR65061Medicare UPIN