Individual
JACKSON COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
50 MOODY ST, SACO, ME 04072-1536
(800) 434-3000
Mailing address
33 OBRION ST, PORTLAND, ME 04101-4411
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC6541
ME
Other
Enumeration date
09/14/2007
Last updated
09/14/2007
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