Provider Demographics
NPI:1508205964
Name:COOPER, ELYSSE MARIE
Entity Type:Individual
Prefix:
First Name:ELYSSE
Middle Name:MARIE
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 THEROUX CT
Mailing Address - Street 2:11 F
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-3283
Mailing Address - Country:US
Mailing Address - Phone:413-204-6898
Mailing Address - Fax:
Practice Address - Street 1:12 THEROUX CT
Practice Address - Street 2:11 F
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-3283
Practice Address - Country:US
Practice Address - Phone:413-204-6898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst