Provider Demographics
NPI:1790548089
Name:COOPERMAN, STACEY (LGPC, MS, NCC)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:COOPERMAN
Suffix:
Gender:F
Credentials:LGPC, MS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3218 FARMINGTON DR
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4827
Mailing Address - Country:US
Mailing Address - Phone:202-244-0818
Mailing Address - Fax:
Practice Address - Street 1:3218 FARMINGTON DR
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4827
Practice Address - Country:US
Practice Address - Phone:202-244-0818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLGPC200001672101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty