Provider Demographics
NPI:1316232226
Name:COOPER, CHANTZY
Entity type:Individual
Prefix:
First Name:CHANTZY
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHANTZY
Other - Middle Name:
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS ED
Mailing Address - Street 1:761 RIVER AVE STE D
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5200
Mailing Address - Country:US
Mailing Address - Phone:732-833-3723
Mailing Address - Fax:888-247-4390
Practice Address - Street 1:761 RIVER AVE STE D
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5200
Practice Address - Country:US
Practice Address - Phone:732-833-3723
Practice Address - Fax:888-247-4390
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ766360101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health