Provider Demographics
NPI:1174557771
Name:COOPER, NANCY E (PHD, CGP)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:E
Last Name:COOPER
Suffix:
Gender:F
Credentials:PHD, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2257 CLINTON AVE S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2623
Mailing Address - Country:US
Mailing Address - Phone:585-442-4010
Mailing Address - Fax:585-442-4012
Practice Address - Street 1:2257 CLINTON AVE S
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2623
Practice Address - Country:US
Practice Address - Phone:585-442-4010
Practice Address - Fax:585-442-4012
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013052103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY118808SCOtherPREFERRED CARE
NYT56-2518081OtherEXCELLUS BCBS