Provider Demographics
NPI:1104111970
Name:COOPER, JESSE M SR (PHD)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:M
Last Name:COOPER
Suffix:SR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:900 HADDON AVE STE 234
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-2111
Mailing Address - Country:US
Mailing Address - Phone:856-858-5830
Mailing Address - Fax:856-858-5833
Practice Address - Street 1:900 HADDON AVE STE 234
Practice Address - Street 2:
Practice Address - City:COLLINGSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08108-2111
Practice Address - Country:US
Practice Address - Phone:856-858-5830
Practice Address - Fax:856-858-5833
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)