Provider Demographics
NPI:1902935653
Name:COOPER, PAUL C (MS, LP)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:C
Last Name:COOPER
Suffix:
Gender:M
Credentials:MS, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 58
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0058
Mailing Address - Country:US
Mailing Address - Phone:917-686-6380
Mailing Address - Fax:
Practice Address - Street 1:79 MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-2955
Practice Address - Country:US
Practice Address - Phone:212-779-2425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129102L00000X
VT0980000222102L00000X
102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst