Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 06278 | MD |
NPI | 1609426998 |
---|---|
Provider Name | Jacqueline Cooper |
First Address | Pikesville, MD 21208-2647 |
Second Address | Baltimore, MD 21217-1425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2019 |
Last Update Date | 18/09/2019 |