Active NPI
Diane M Cooper, LCSW
- Clinical Social Worker
- Portland, OR
National Provider Identifier
1104262328
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 3927
- Practice address
- 10819 SW Canterbury LN
203
Portland, OR 97224-3848 - Phone
- (503) 308-2408
- NPI assigned
- May 14, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 060662 | NY | |
| Clinical Social Worker | 1041C0700X | 3927 | OR | Primary |
Addresses
Primary practice location
10819 SW Canterbury LN
203
Portland, OR 97224-3848
Mailing address
10819 SW Canterbury LN
203
Portland, OR 97224-3848
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 164936 | Medicaid | OR | |
| 0000WDBCH | Other | WA | MEDICARE GROUP # |
| 0000WDBCH | Other | OR | MEDICARE GROUP # |
Other names 1
- Dee M Cooper
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3927 | OR | MD | Clinical Psychologist |
| 060662 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1368489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1368489600000",
"number": "1104262328",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10819 SW CANTERBURY LN",
"address_2": "203",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972243848"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10819 SW CANTERBURY LN",
"address_2": "203",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972243848",
"telephone_number": "503-308-2408"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COOPER",
"first_name": "DIANE",
"middle_name": "M",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-05-14",
"last_updated": "2013-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "060662",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": "3927",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "164936",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP #",
"identifier": "0000WDBCH",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP #",
"identifier": "0000WDBCH",
"state": "OR"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "DEE",
"last_name": "COOPER",
"middle_name": "M",
"credential": "LCSW",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.