Provider Demographics
NPI:1407956196
Name:COOPER, ROBERT PORTER (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PORTER
Last Name:COOPER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 PETERS AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-6676
Mailing Address - Country:US
Mailing Address - Phone:925-830-3911
Mailing Address - Fax:925-399-5552
Practice Address - Street 1:533 PETERS AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6676
Practice Address - Country:US
Practice Address - Phone:925-830-3911
Practice Address - Fax:925-399-5552
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11145103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY11145OtherBLUE CROSS OF CALIFORNIA
CA0PL111450Medicare PIN