Provider Demographics
NPI:1487984282
Name:COOPER, LOWELL WARREN (PHD)
Entity type:Individual
Prefix:DR
First Name:LOWELL
Middle Name:WARREN
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 1:2000 DWIGHT WAY
Mailing Address - Street 2:STE C
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704
Mailing Address - Country:US
Mailing Address - Phone:510-841-1252
Mailing Address - Fax:510-841-1252
Practice Address - Street 1:2000 DWIGHT WAY
Practice Address - Street 2:STE C
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704
Practice Address - Country:US
Practice Address - Phone:510-841-1252
Practice Address - Fax:510-841-1252
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY3256103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical