Healthcare Provider Details

I. General information

NPI: 1497088934
Provider Name (Legal Business Name): MARTY AARON COOPER PHD, LMHC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BROADWAY # 331A
BROOKLYN NY
11249-6044
US

IV. Provider business mailing address

100A BROADWAY # 331
BROOKLYN NY
11249-6127
US

V. Phone/Fax

Practice location:
  • Phone: 347-244-7873
  • Fax:
Mailing address:
  • Phone: 347-244-7873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: