Provider Demographics
NPI:1285819896
Name:COOPER, JOHN REMO (PSYS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:REMO
Last Name:COOPER
Suffix:
Gender:M
Credentials:PSYS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 JACKSON PL APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-5547
Mailing Address - Country:US
Mailing Address - Phone:917-881-5322
Mailing Address - Fax:
Practice Address - Street 1:19 JACKSON PL APT 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-5547
Practice Address - Country:US
Practice Address - Phone:917-881-5322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool