Individual
MR. DEION COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
501 LOMBARD ST, NEW HAVEN, CT 06513-2910
(203) 787-2207
Mailing address
501 LOMBARD ST, NEW HAVEN, CT 06513-2910
(203) 787-2207
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2962
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06-0667607
—
CT
Enumeration date
11/16/2016
Last updated
11/16/2016
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