Individual
TARIQUE COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC II
Contact information
Practice address
90 MADISON STREET, SUITE 502, WORCESTER, MA 01608
(774) 530-6363
Mailing address
90 MADISON STREET, UNIT 608, WORCESTER, MA 01608
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
24408
MA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
05/13/2025
Last updated
05/15/2025
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