Provider Demographics
NPI:1881771848
Name:COOPER, MARLENE G (PHD LCSW)
Entity type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:G
Last Name:COOPER
Suffix:
Gender:F
Credentials:PHD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2223 ROSSINI LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-3212
Mailing Address - Country:US
Mailing Address - Phone:732-967-1659
Mailing Address - Fax:
Practice Address - Street 1:2223 ROSSINI LN
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-3212
Practice Address - Country:US
Practice Address - Phone:732-967-1659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO114501041C0700X
1041C0700X
NJ44SCO14360001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
146934OtherBEACON HEALTH OPTIONS
NYNS350OtherOXFORD HEALTH PLAN
NY0082299OtherGHI/VALUE OPTIONS