Provider Demographics
NPI:1740669183
Name:COSPER, PAMELA ROSE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ROSE
Last Name:COSPER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SHERWOOD DR STE C
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-3086
Mailing Address - Country:US
Mailing Address - Phone:570-204-4028
Mailing Address - Fax:
Practice Address - Street 1:16 SHERWOOD DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-3086
Practice Address - Country:US
Practice Address - Phone:570-204-4028
Practice Address - Fax:570-445-2214
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0189641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1035723800001Medicaid
PA0019468810006Medicaid