Provider Demographics
NPI:1366197683
Name:COSSABOON, SIRPA HANNELE (PHD)
Entity type:Individual
Prefix:
First Name:SIRPA
Middle Name:HANNELE
Last Name:COSSABOON
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 1:112 AIRPORT RD STE 334
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-5800
Mailing Address - Country:US
Mailing Address - Phone:484-775-0822
Mailing Address - Fax:
Practice Address - Street 1:505 MAIN ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:DE
Practice Address - Zip Code:19730-2013
Practice Address - Country:US
Practice Address - Phone:302-279-6491
Practice Address - Fax:302-722-5464
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty