MEDICARE: DR. DANIELLE COOPER PHD

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	103TC0700X	Clinical Psychologist	PS019251	PA

General Provider Information

NPI Number	:	1669050472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIELLE COOPER PHD

Provider Business Mailing Address
First Line	:	1308 E COLORADO BLVD # 2255
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-1932
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1308 E COLORADO BLVD # 2255
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-1932
Country	:	US
Telephone Number	:	626-493-2165
Fax Number	:

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

Provider Enumeration Date	:	04/01/2021
Last Update Date	:	07/30/2024

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