Provider Demographics
NPI:1093910549
Name:COOPER, CAREN LYNN (PSYD, LMFT)
Entity Type:Individual
Prefix:
First Name:CAREN
Middle Name:LYNN
Last Name:COOPER
Suffix:
Gender:F
Credentials:PSYD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5319 SAXON ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-1144
Mailing Address - Country:US
Mailing Address - Phone:619-665-1495
Mailing Address - Fax:
Practice Address - Street 1:6540 LUSK BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2767
Practice Address - Country:US
Practice Address - Phone:858-255-1532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT23586106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist