Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY 19966 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY 19966 | CA |
NPI | 1003978552 |
---|---|
Provider Name | Dr. Anne Cooper |
First Address | Menlo Park, CA 94025 |
Second Address | Menlo Park, CA 94025-4003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 08/07/2007 |