Healthcare Provider Details

I. General information

NPI: 1427299437
Provider Name (Legal Business Name): JOAN T COOPER PHD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2009
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8259 N MILITARY TRL SUITE 12
WEST PALM BEACH FL
33410-6352
US

IV. Provider business mailing address

8259 N MILITARY TRL SUITE 12
WEST PALM BEACH FL
33410-6352
US

V. Phone/Fax

Practice location:
  • Phone: 561-776-2260
  • Fax:
Mailing address:
  • Phone: 561-776-2260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY7117
License Number StateFL

VIII. Authorized Official

Name: JOAN T COOPER
Title or Position: OWNER
Credential: PHD
Phone: 561-776-2266