Healthcare Provider Details

I. General information

NPI: 1255537809
Provider Name (Legal Business Name): JAMES J COUPE III PSY.D., MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 COULTER AVE
ARDMORE PA
19003-2410
US

IV. Provider business mailing address

103 LINCOLN CIR
BROOMALL PA
19008-1502
US

V. Phone/Fax

Practice location:
  • Phone: 610-642-4873
  • Fax:
Mailing address:
  • Phone: 484-422-8460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS015639
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: