Healthcare Provider Details

I. General information

NPI: 1326582453
Provider Name (Legal Business Name): COOPER MENTAL HEALTH COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2016
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 W 26TH ST # 804
NEW YORK NY
10001-6700
US

IV. Provider business mailing address

226 W 26TH ST # 804
NEW YORK NY
10001-6700
US

V. Phone/Fax

Practice location:
  • Phone: 347-244-8783
  • Fax:
Mailing address:
  • Phone: 347-244-8783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number021944
License Number StateNY

VIII. Authorized Official

Name: DR. MARTY AARON COOPER
Title or Position: OWNER
Credential: PHD
Phone: 347-244-7873