Provider Demographics
NPI:1629889365
Name:COOPER, JAMAL MARIO (BCABA)
Entity type:Individual
Prefix:
First Name:JAMAL
Middle Name:MARIO
Last Name:COOPER
Suffix:
Gender:M
Credentials:BCABA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:17 PARK OF COMMERCE BLVD STE 103105
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-7436
Mailing Address - Country:US
Mailing Address - Phone:718-215-5311
Mailing Address - Fax:718-865-5165
Practice Address - Street 1:17 PARK OF COMMERCE BLVD STE 103105
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-7436
Practice Address - Country:US
Practice Address - Phone:718-215-5311
Practice Address - Fax:718-865-5165
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst