Individual
DIANE M COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
10819 SW CANTERBURY LN, 203, PORTLAND, OR 97224-3848
(503) 308-2408
Mailing address
10819 SW CANTERBURY LN, 203, PORTLAND, OR 97224-3848
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
060662
NY
1041C0700X
Clinical Social Worker
Primary
3927
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000WDBCH
MEDICARE GROUP #
OR
01
—
0000WDBCH
MEDICARE GROUP #
WA
05
—
164936
—
OR
Enumeration date
05/14/2013
Last updated
05/14/2013
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