Provider Demographics
NPI:1023140365
Name:COOPER, CALLIE A (LSW)
Entity type:Individual
Prefix:MS
First Name:CALLIE
Middle Name:A
Last Name:COOPER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5725 FORWARD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-2255
Mailing Address - Country:US
Mailing Address - Phone:412-745-8703
Mailing Address - Fax:412-745-8706
Practice Address - Street 1:5725 FORWARD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-2255
Practice Address - Country:US
Practice Address - Phone:412-745-8703
Practice Address - Fax:412-745-8706
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW008041L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker