Provider Demographics
NPI:1841919412
Name:COOPER, SUZANNE EVANGELINE (LCSW)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:EVANGELINE
Last Name:COOPER
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 1:4504 GLADWYNE DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4711
Mailing Address - Country:US
Mailing Address - Phone:703-606-5955
Mailing Address - Fax:
Practice Address - Street 1:127 PARK ST NE
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4602
Practice Address - Country:US
Practice Address - Phone:703-281-2657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040139581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical