1891735726 NPI number — ROCHELLE COOPER CNS

Table of content: ROCHELLE COOPER CNS (NPI 1891735726)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891735726 NPI number — ROCHELLE COOPER CNS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOPER
Provider First Name:
ROCHELLE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891735726
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1316 POSEIDON PT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VERO BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32963-3144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-924-0851
Provider Business Mailing Address Fax Number:
617-923-7073

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 WATERTOWN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERTOWN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02472-2505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-647-0323
Provider Business Practice Location Address Fax Number:
508-746-4140
Provider Enumeration Date:
06/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364S00000X , with the licence number:  165764 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PN0359 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1851683 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".