Addison Cooper, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

27804 Issued in CA

Practice address

1881 Business Center Dr Ste 10a
San Bernardino, CA 92408-3438

Phone

(909) 890-2381

NPI assigned

Dec 20, 2012

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Koinonia Foster Homes, Inc.

  • Mental Illness Community Based Residential Treatment Facility
  • Antelope, CA
  • NPI 1831506534
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1355961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485475200000",
    "number": "1578809463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1881 BUSINESS CENTER DR STE 10A",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924083438",
            "telephone_number": "909-890-2381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1881 BUSINESS CENTER DR STE 10A",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924083438",
            "telephone_number": "909-890-2381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOPER",
        "first_name": "ADDISON",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-12-20",
        "last_updated": "2017-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "27804",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2012015566",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "2012015566",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "27804",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Roberto Contreras II, M.D.
• Rosie Cook-Askins
• Angie Bagheri Cook, DO
• Crystal Rebecca Anne Cook
• Sabrina Marie Cooksey, CPM, LM
• Ameerah Cooper
• Cynthia E. Cooper
• Margo Elaine Cooper
• Donna E Copeland
• Heather Reanna Copeland, MFT-I

• Clinical Social Worker in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.