Provider Demographics
NPI:1124246434
Name:GRAVES-COOPER, PHYLLIS JANE (PHD)
Entity type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:JANE
Last Name:GRAVES-COOPER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 SCARBOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-6561
Mailing Address - Country:US
Mailing Address - Phone:845-278-0444
Mailing Address - Fax:845-278-0444
Practice Address - Street 1:967 ROUTE 22
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-1526
Practice Address - Country:US
Practice Address - Phone:845-529-3900
Practice Address - Fax:845-278-0444
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012874103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical