Provider Demographics
NPI:1982425211
Name:COOPER, GRACE KAY (LCSW)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:KAY
Last Name:COOPER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 SONGBIRD DR UNIT 2102
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-5112
Mailing Address - Country:US
Mailing Address - Phone:239-272-7706
Mailing Address - Fax:
Practice Address - Street 1:669 HADLEY ST E
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-0881
Practice Address - Country:US
Practice Address - Phone:239-272-7706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-19
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW236311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW23631OtherLCSW