Provider Demographics
NPI:1568630630
Name:COOPER, JUSTIN CRAIG (LSW)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:CRAIG
Last Name:COOPER
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 NEW CASTLE RD
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-2418
Mailing Address - Country:US
Mailing Address - Phone:724-287-4781
Mailing Address - Fax:
Practice Address - Street 1:325 NEW CASTLE ROAD
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-5241
Practice Address - Country:US
Practice Address - Phone:724-284-4894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW126073104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker