Provider Demographics
NPI:1881016863
Name:COOPERSTEIN, MEGAN (BA LCDC III)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:COOPERSTEIN
Suffix:
Gender:F
Credentials:BA LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45214-1402
Mailing Address - Country:US
Mailing Address - Phone:513-557-2500
Mailing Address - Fax:513-557-2510
Practice Address - Street 1:1616 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45214-1402
Practice Address - Country:US
Practice Address - Phone:513-557-2500
Practice Address - Fax:513-557-2510
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH111122324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility