Provider Demographics
NPI:1487277786
Name:COOPER, JANIS GILBERT (LCSW)
Entity type:Individual
Prefix:
First Name:JANIS
Middle Name:GILBERT
Last Name:COOPER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JANIS
Other - Middle Name:HELENE
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:821 REGULUS ST
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-2725
Mailing Address - Country:US
Mailing Address - Phone:650-773-2087
Mailing Address - Fax:
Practice Address - Street 1:821 REGULUS ST
Practice Address - Street 2:
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-2725
Practice Address - Country:US
Practice Address - Phone:650-773-0383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical