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NPI Code Detail

MEDICARE: DR. CLARENCE COOPER ED.D, BCBA-D

MEDICARE: DR. CLARENCE COOPER ED.D, BCBA-D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2171M00000XCase Manager/Care Coordinator
3103K00000XBehavior Analyst1-24-70821

General Provider Information

NPI Number : 1033501911
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CLARENCE COOPER ED.D, BCBA-D
Provider Business Mailing Address
First Line : 4900 EVERGREEN AVE
Second Line :
City : FORT PIERCE
State : FL
Zip : 34947-1646
Country : US
Telephone Number : 772-538-2188
Fax Number :
Provider Business Practice Location Address
First Line : 2500 N MILITARY TRL STE 304
Second Line :
City : BOCA RATON
State : FL
Zip : 33431-6324
Country : US
Telephone Number : 772-362-9878
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2015
Last Update Date : 05/22/2025

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