| NPI | 1679639702 |
|---|---|
| Former Name | STACEY M COOPER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 11098) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NH 1098) |
| Enumeration Date | 2007-01-01 |
| Last Update Date | 2007-07-08 |