Provider Demographics
NPI:1861264020
Name:COOPER, JOSHUA JACKSON (SOCIAL WORKER)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JACKSON
Last Name:COOPER
Suffix:
Gender:M
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 ASHMUN AVE
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-1675
Mailing Address - Country:US
Mailing Address - Phone:330-907-7066
Mailing Address - Fax:
Practice Address - Street 1:10 PENFIELD AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-2912
Practice Address - Country:US
Practice Address - Phone:330-762-6110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.183527101YA0400X
OHS.2309272104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)