Provider Demographics
NPI:1891886610
Name:COOPER, DANIEL E (LPCMH)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:E
Last Name:COOPER
Suffix:
Gender:M
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 E. STEIN HWY
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-1416
Mailing Address - Country:US
Mailing Address - Phone:302-628-7781
Mailing Address - Fax:302-628-7783
Practice Address - Street 1:308 E. STEIN HWY
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-1416
Practice Address - Country:US
Practice Address - Phone:302-628-7781
Practice Address - Fax:302-628-7783
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC 0000288101YM0800X
DEPC-0000288101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000916802Medicaid
DE1000022920Medicaid