Provider Demographics
NPI:1558396945
Name:COOPER, JANICE MARION
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:MARION
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 1:4949 LIBERTY LANE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WESCOSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9017
Mailing Address - Country:US
Mailing Address - Phone:610-821-9422
Mailing Address - Fax:610-820-6308
Practice Address - Street 1:4949 LIBERTY LN
Practice Address - Street 2:SUITE 5
Practice Address - City:WESCOSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18106-9014
Practice Address - Country:US
Practice Address - Phone:610-821-9422
Practice Address - Fax:610-820-6308
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS 001285-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01744201OtherCAPITAL BLUE CROSS
PA7160053OtherAETNA
PAP3300773OtherOXFORD
PA1034698OtherCIGNA
PA132334000OtherMAGELLAN
PA0059905000OtherINDEPENDENCE BLUE CROSS
PA1664534OtherAMERIHEALTH
PA338509OtherHIGHMARK BLUE SHIELD
PA1394296Medicaid
PA164557OtherVALUE OPTIONS
PA254837OtherMANAGED HEALTH NETWORK
PA1394296Medicaid