Provider Demographics
NPI:1992244529
Name:COOPER, JOSHUA AARON (BCBA)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:AARON
Last Name:COOPER
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3974 48TH ST
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-1022
Mailing Address - Country:US
Mailing Address - Phone:631-617-9952
Mailing Address - Fax:
Practice Address - Street 1:3974 48TH ST
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-1022
Practice Address - Country:US
Practice Address - Phone:631-617-9952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP05116103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst