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NPI Code Detail

MEDICARE: ANTIONETTE T COOPER PSYD

MEDICARE:   ANTIONETTE T COOPER  PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist5307OH

General Provider Information

NPI Number : 1134169154
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTIONETTE T COOPER PSYD
Provider Business Mailing Address
First Line : 1790 TOWN PARK BLVD
Second Line : STE C
City : UNIONTOWN
State : OH
Zip : 44685-7972
Country : US
Telephone Number : 330-753-1734
Fax Number :
Provider Business Practice Location Address
First Line : 1790 TOWN PARK BLVD
Second Line : STE C
City : UNIONTOWN
State : OH
Zip : 44685-7972
Country : US
Telephone Number : 330-753-1734
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2006
Last Update Date : 05/05/2017

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Directions to “ ANTIONETTE T COOPER PSYD” Practice Location

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