Provider Demographics
NPI:1245692508
Name:COOPERSTEIN, DAWN ANNE (LCSW)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:ANNE
Last Name:COOPERSTEIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:ANNE
Other - Last Name:WEISENBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:9555 E SHILOH ST APT 5104
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85748-3246
Mailing Address - Country:US
Mailing Address - Phone:520-462-8559
Mailing Address - Fax:520-336-9707
Practice Address - Street 1:9555 E SHILOH ST APT 5104
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85748-3246
Practice Address - Country:US
Practice Address - Phone:520-462-8559
Practice Address - Fax:520-336-9707
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-25
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040093381041C0700X
AZ185321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904009338OtherLCSW LICENSE
VA1245692508Medicaid
AZ18532OtherLCSW LICENSE