Provider Demographics
NPI:1801586821
Name:GALLARDO-COOPER, MARIA ISABEL (PHD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ISABEL
Last Name:GALLARDO-COOPER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:G
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:146 VIA CASTILLA
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-6919
Mailing Address - Country:US
Mailing Address - Phone:561-262-8818
Mailing Address - Fax:
Practice Address - Street 1:3301 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-7796
Practice Address - Country:US
Practice Address - Phone:954-262-5730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMFT565106H00000X
FLSS213103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist