Provider Demographics
NPI:1497805840
Name:COOPER, ROBYN JILL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROBYN
Middle Name:JILL
Last Name:COOPER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:ROBYN
Other - Middle Name:JILL
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYCHOLOGIST
Mailing Address - Street 1:241 W 97TH ST
Mailing Address - Street 2:10N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6255
Mailing Address - Country:US
Mailing Address - Phone:212-662-7665
Mailing Address - Fax:212-420-1230
Practice Address - Street 1:611 BROADWAY
Practice Address - Street 2:SUITE 629
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2608
Practice Address - Country:US
Practice Address - Phone:212-420-8130
Practice Address - Fax:212-420-1230
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008370103TC0700X
NY8370-1102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst