Healthcare Provider Details

I. General information

NPI: 1487859757
Provider Name (Legal Business Name): MARCY COOPER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/16/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5277 MANHATTAN CIRCLE SUITE 110
BOULDER CO
80303
US

IV. Provider business mailing address

5277 MANHATTAN CIRCLE SUITE 110
BOULDER CO
80303
US

V. Phone/Fax

Practice location:
  • Phone: 303-666-0443
  • Fax: 303-666-7505
Mailing address:
  • Phone: 303-666-0443
  • Fax: 303-666-7505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number37992
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: