Provider Demographics
NPI:1487793865
Name:COOPER, MARTY L
Entity type:Individual
Prefix:
First Name:MARTY
Middle Name:L
Last Name:COOPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4831 GEARY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-2910
Mailing Address - Country:US
Mailing Address - Phone:415-835-2162
Mailing Address - Fax:
Practice Address - Street 1:251 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-1630
Practice Address - Country:US
Practice Address - Phone:650-368-2383
Practice Address - Fax:650-368-0599
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor