MEDICARE: COOPER PSYCHOLOGICAL ASSOCIATES, INC.

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
1	103T00000X	Psychologist	PS 001285-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02308900	OTHER	PA	CAPITAL BLUE CROSS
2	338509	OTHER	PA	HIGHMAR BLUE SHIELD
3	257539000	OTHER	PA	MAGELLAN
4	0059905000	OTHER	PA	INDEPENDENCE BLUE CROSS
5	293720	OTHER	PA	MANAGED HEALTH NETWORK
6	1663388	OTHER	PA	AMERIHEALTH
7	7973084	OTHER	PA	AETNA
8	C38509	OTHER	PA	EPHN

General Provider Information

NPI Number	:	1306872924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COOPER PSYCHOLOGICAL ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	4949 LIBERTY LANE
Second Line	:	SUITE 5
City	:	WESCOSVILLE
State	:	PA
Zip	:	18106-9017
Country	:	US
Telephone Number	:	610-821-9422
Fax Number	:	610-820-6308

Provider Business Practice Location Address
First Line	:	4949 LIBERTY LN
Second Line	:	SUITE 5
City	:	WESCOSVILLE
State	:	PA
Zip	:	18106-9014
Country	:	US
Telephone Number	:	610-821-9422
Fax Number	:	610-820-6308

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. JANICE MARION COOPER
Credential	:
Telephone Number	:	610-821-9422

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	04/28/2016

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