Provider Demographics
NPI:1043294325
Name:COOPER, PAULA (PHD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 BAHIA VISTA ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2625
Mailing Address - Country:US
Mailing Address - Phone:941-685-6098
Mailing Address - Fax:941-776-8956
Practice Address - Street 1:2650 BAHIA VISTA ST STE 201
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2625
Practice Address - Country:US
Practice Address - Phone:941-685-6098
Practice Address - Fax:941-776-8956
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7184103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist