Provider Demographics
NPI:1700940368
Name:COOPER, PAMELA GOODFRIEND (LCSW, CAC III)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:GOODFRIEND
Last Name:COOPER
Suffix:
Gender:F
Credentials:LCSW, CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 EISENHOWER DR
Mailing Address - Street 2:#137
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1152
Mailing Address - Country:US
Mailing Address - Phone:303-269-1191
Mailing Address - Fax:
Practice Address - Street 1:3570 E 12TH AVE
Practice Address - Street 2:303
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-3434
Practice Address - Country:US
Practice Address - Phone:303-269-1191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC809003OtherMEDICARE PTAN
CO405164OtherMEDICARE GROUP PTAN