Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 44SL05596700 | NJ |
NPI | 1003111345 |
---|---|
Provider Name | Mr. David Alexander Cooper |
First Address | Matawan, NJ 07747-3104 |
Second Address | Matawan, NJ 07747-3104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2011 |
Last Update Date | 18/01/2011 |