=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518131358
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBYN COOPER, PSYD., PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2008
-----------------------------------------------------
Last Update Date | 04/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 611 BROADWAY 629
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10012-2608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-420-8130
-----------------------------------------------------
Fax | 212-420-1230
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 611 BROADWAY 629
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10012-2608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-420-8130
-----------------------------------------------------
Fax | 212-420-1230
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST
-----------------------------------------------------
Name | DR. ROBYN JILL COOPER
-----------------------------------------------------
Credential | PSYD.
-----------------------------------------------------
Telephone | 212-420-8130
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 8370
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------