Provider Demographics
NPI:1245565761
Name:COOPER, DAVID E (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
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 1:4501 CONNECTICUT AVE NW
Mailing Address - Street 2:SUITE 1011
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-3710
Mailing Address - Country:US
Mailing Address - Phone:202-360-4787
Mailing Address - Fax:202-360-4787
Practice Address - Street 1:4501 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE 1011
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-3710
Practice Address - Country:US
Practice Address - Phone:202-360-4787
Practice Address - Fax:202-360-4787
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1727103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical