Provider Demographics
NPI:1104025469
Name:COOPERMAN, ROBERT J (LPC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:COOPERMAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 FARMINGTON AVE STE F
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2362
Mailing Address - Country:US
Mailing Address - Phone:860-655-8555
Mailing Address - Fax:
Practice Address - Street 1:780 FARMINGTON AVE STE F
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2362
Practice Address - Country:US
Practice Address - Phone:860-655-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001311101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional