Provider Demographics
NPI:1750408555
Name:COOPER, DENISE MARIE (PC)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:MARIE
Last Name:COOPER
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3416 TUXEDO AVE
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-1239
Mailing Address - Country:US
Mailing Address - Phone:216-661-4959
Mailing Address - Fax:
Practice Address - Street 1:12200 FAIRHILL RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-1058
Practice Address - Country:US
Practice Address - Phone:216-791-9303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0600329101YP2500X
221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist