Provider Demographics
NPI:1932253226
Name:COOPER, DEANNA R (MA, ART, LMHC)
Entity type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:R
Last Name:COOPER
Suffix:
Gender:F
Credentials:MA, ART, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:33 MYRTLE ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3805
Mailing Address - Country:US
Mailing Address - Phone:617-584-9109
Mailing Address - Fax:617-569-3516
Practice Address - Street 1:14 PORTER ST
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-2116
Practice Address - Country:US
Practice Address - Phone:617-569-3189
Practice Address - Fax:617-569-7890
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6032101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health