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General NPI Number Information
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NPI Number | 1992695928
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Entity Type | Individual
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Provider Name | JESSICA COOPERMAN PSYD
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Gender | Female
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Dates
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Enumeration Date | 07/09/2025
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 1 MIFFLIN PL
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City | CAMBRIDGE
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State | MA
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Zip | 02138-4907
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Country | US
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Telephone | 845-652-3783
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Fax |
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Provider Business Mailing Address
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Address Line | 801 S 47TH ST APT 301
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City | PHILADELPHIA
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State | PA
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Zip | 19143-3652
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Country | US
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Telephone | 845-652-3783
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS020521
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License Number State | PA
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