Provider Demographics
NPI:1386439552
Name:COOPER, RACHEL NICOLE (MS, MA)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:NICOLE
Last Name:COOPER
Suffix:
Gender:
Credentials:MS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18221 FOX CHASE CIR
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-3003
Mailing Address - Country:US
Mailing Address - Phone:301-525-2140
Mailing Address - Fax:
Practice Address - Street 1:166 DEFENSE HWY STE 203
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-8922
Practice Address - Country:US
Practice Address - Phone:410-684-3806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
MDA0907390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No103T00000XBehavioral Health & Social Service ProvidersPsychologist