Provider Demographics
NPI:1376608778
Name:COOPER, MARC D (MA)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:D
Last Name:COOPER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 CAIRNSMUIR LN
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-6723
Mailing Address - Country:US
Mailing Address - Phone:845-639-1955
Mailing Address - Fax:
Practice Address - Street 1:1979 MARCUS AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1002
Practice Address - Country:US
Practice Address - Phone:516-327-4681
Practice Address - Fax:516-327-4684
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral