MEDICARE: DR. ANNE 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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	103T00000X	Psychologist	11420	MA

General Provider Information

NPI Number	:	1588057012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNE COOPER PSYD

Provider Business Mailing Address
First Line	:	265 LAFAYETTE ST APT 3
Second Line	:
City	:	SALEM
State	:	MA
Zip	:	01970-5794
Country	:	US
Telephone Number	:	978-473-7961
Fax Number	:

Provider Business Practice Location Address
First Line	:	265 LAFAYETTE ST APT 3
Second Line	:
City	:	SALEM
State	:	MA
Zip	:	01970-5794
Country	:	US
Telephone Number	:	978-473-7961
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2015
Last Update Date	:	02/05/2021

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Directions to “ DR. ANNE COOPER PSYD” Practice Location

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