Healthcare Provider Details

I. General information

NPI: 1902935653
Provider Name (Legal Business Name): PAUL C COOPER MS, LP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 MAIN ST STE 5
MONTPELIER VT
05602-2955
US

IV. Provider business mailing address

PO BOX 58
BARRE VT
05641-0058
US

V. Phone/Fax

Practice location:
  • Phone: 212-779-2425
  • Fax:
Mailing address:
  • Phone: 917-686-6380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number129
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number0980000222
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: