Provider Demographics
NPI:1649850058
Name:COOPER, DANIEL J (LPC, CAADC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:COOPER
Suffix:
Gender:M
Credentials:LPC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 YEARSLEY MILL RD
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5593
Mailing Address - Country:US
Mailing Address - Phone:484-227-1523
Mailing Address - Fax:
Practice Address - Street 1:100 YEARSLEY MILL RD
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5593
Practice Address - Country:US
Practice Address - Phone:484-227-1523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2024-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC014605101YA0400X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)