Provider Demographics
NPI:1922681972
Name:COOPERSMITH, JAKE (LPC)
Entity Type:Individual
Prefix:
First Name:JAKE
Middle Name:
Last Name:COOPERSMITH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 STURBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-9037
Mailing Address - Country:US
Mailing Address - Phone:860-368-8665
Mailing Address - Fax:
Practice Address - Street 1:50 STURBRIDGE CT
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-9037
Practice Address - Country:US
Practice Address - Phone:860-368-8665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty