Provider Demographics
NPI:1952400772
Name:MCCOOL, JOSEPH R (EDD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:R
Last Name:MCCOOL
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 BELMONT STREET
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4430
Mailing Address - Country:US
Mailing Address - Phone:508-580-2137
Mailing Address - Fax:508-559-6143
Practice Address - Street 1:1350 BELMONT STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4430
Practice Address - Country:US
Practice Address - Phone:508-580-2137
Practice Address - Fax:508-559-6143
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2085103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
S004933OtherCHAMPUS
MAW02273OtherBCBS MA
MAW02273Medicare ID - Type Unspecified