Provider Demographics
NPI:1487829875
Name:COOPERMAN, MARILYN LESLIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:LESLIE
Last Name:COOPERMAN
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 1:15 LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-7254
Mailing Address - Country:US
Mailing Address - Phone:914-472-9415
Mailing Address - Fax:914-472-9415
Practice Address - Street 1:15 LINCOLN RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-7254
Practice Address - Country:US
Practice Address - Phone:914-472-9415
Practice Address - Fax:914-472-9415
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004950103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist