Provider Demographics
NPI:1316165640
Name:PHYLLIS GRAVES-COOPER,PH.D.-PSYCHOLOGIST LLC
Entity type:Organization
Organization Name:PHYLLIS GRAVES-COOPER,PH.D.-PSYCHOLOGIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:DR
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:GRAVES-COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:845-278-0444
Mailing Address - Street 1:1102 SCARBOROUGH DRIVE
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:10509-6561
Practice Address - Country:US
Practice Address - Phone:845-529-3900
Practice Address - Fax:845-278-0444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012874103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty