Provider Demographics
NPI:1659362606
Name:COOPER, LESLIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:COOPER
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 1:9208 GLENVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-3635
Mailing Address - Country:US
Mailing Address - Phone:301-408-1444
Mailing Address - Fax:202-782-1234
Practice Address - Street 1:6900 GEORGIA AVE., N.W., WARD 55
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-0001
Practice Address - Country:US
Practice Address - Phone:202-782-5903
Practice Address - Fax:202-782-1234
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000260103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist