Provider Demographics
NPI:1427299437
Name:JOAN T COOPER PHD PA
Entity type:Organization
Organization Name:JOAN T COOPER PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:561-776-2266
Mailing Address - Street 1:8259 N MILITARY TRL
Mailing Address - Street 2:SUITE 12
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6352
Mailing Address - Country:US
Mailing Address - Phone:561-776-2260
Mailing Address - Fax:
Practice Address - Street 1:8259 N MILITARY TRL
Practice Address - Street 2:SUITE 12
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-6352
Practice Address - Country:US
Practice Address - Phone:561-776-2260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7117103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU8442YMedicare PIN