MEDICARE: MS. JANICE MARION COOPER

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
1	103T00000X	Psychologist	PS 001285-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01744201	OTHER	PA	CAPITAL BLUE CROSS
2	7160053	OTHER	PA	AETNA
3	P3300773	OTHER	PA	OXFORD
4	1034698	OTHER	PA	CIGNA
5	132334000	OTHER	PA	MAGELLAN
6	0059905000	OTHER	PA	INDEPENDENCE BLUE CROSS
7	1664534	OTHER	PA	AMERIHEALTH
8	338509	OTHER	PA	HIGHMARK BLUE SHIELD
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	164557	OTHER	PA	VALUE OPTIONS
11	254837	OTHER	PA	MANAGED HEALTH NETWORK

General Provider Information

NPI Number	:	1558396945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANICE MARION COOPER

Provider Business Mailing Address
First Line	:	4949 LIBERTY LANE
Second Line	:	SUITE 5
City	:	WESCOSVILLE
State	:	PA
Zip	:	18106-9017
Country	:	US
Telephone Number	:	610-821-9422
Fax Number	:	610-820-6308

Provider Business Practice Location Address
First Line	:	4949 LIBERTY LN
Second Line	:	SUITE 5
City	:	WESCOSVILLE
State	:	PA
Zip	:	18106-9014
Country	:	US
Telephone Number	:	610-821-9422
Fax Number	:	610-820-6308

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	05/16/2016

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Directions to “ MS. JANICE MARION COOPER ” Practice Location

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