Provider Demographics
NPI:1295322907
Name:COOPER, ROBIN COLLEEN (LCSW, MSW)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:COLLEEN
Last Name:COOPER
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 SAN LORENZO CT
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-0607
Mailing Address - Country:US
Mailing Address - Phone:941-799-0559
Mailing Address - Fax:
Practice Address - Street 1:410 SAN LORENZO CT
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-0607
Practice Address - Country:US
Practice Address - Phone:941-799-0559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX664851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical