Provider Demographics
NPI:1891323846
Name:COOPER, CANDACE L (MSW)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:L
Last Name:COOPER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 NORTON PARK DR APT 230
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:OH
Mailing Address - Zip Code:43213-3566
Mailing Address - Country:US
Mailing Address - Phone:567-868-3388
Mailing Address - Fax:
Practice Address - Street 1:101 NORTON PARK DR APT 230
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:OH
Practice Address - Zip Code:43213-3566
Practice Address - Country:US
Practice Address - Phone:567-868-3388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-27
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty