Provider Demographics
NPI:1639759632
Name:COOPER, JAZMINE (MS MS)
Entity Type:Individual
Prefix:DR
First Name:JAZMINE
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:MS MS
Other - Prefix:DR
Other - First Name:PHOENIX
Other - Middle Name:JAZMINE
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD MS
Mailing Address - Street 1:1650 W CHESTER PIKE APT MC3
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-6219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 E 210TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2401
Practice Address - Country:US
Practice Address - Phone:718-320-5300
Practice Address - Fax:718-320-1116
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program