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NPI Code Detail

MEDICARE: MARJORIE BARBARA COOPER-NICOLS PH.D.

MEDICARE: MARJORIE BARBARA COOPER-NICOLS PH.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
1103TC0700XClinical Psychologist019594-1NY

General Provider Information

NPI Number : 1497827380
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARJORIE BARBARA COOPER-NICOLS PH.D.
Provider Business Mailing Address
First Line : 95 W 18TH ST
Second Line :
City : DEER PARK
State : NY
Zip : 11729-3907
Country : US
Telephone Number : 631-243-5835
Fax Number :
Provider Business Practice Location Address
First Line : 3512 QUENTIN RD
Second Line :
City : BROOKLYN
State : NY
Zip : 11234-4231
Country : US
Telephone Number : 800-275-3243
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2006
Last Update Date : 06/05/2012

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Directions to “ MARJORIE BARBARA COOPER-NICOLS PH.D.” Practice Location

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