Provider Demographics
NPI:1881762235
Name:COOPER, LYNN K (EDD, ABPP)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:K
Last Name:COOPER
Suffix:
Gender:F
Credentials:EDD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 KENRICK ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-2733
Mailing Address - Country:US
Mailing Address - Phone:617-527-3152
Mailing Address - Fax:617-332-6442
Practice Address - Street 1:262 KENRICK ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-2733
Practice Address - Country:US
Practice Address - Phone:617-527-3152
Practice Address - Fax:617-332-6442
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPSY1224103TC0700X, 103T00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW01071Medicare ID - Type Unspecified