Provider Demographics
NPI:1548306384
Name:COOLEY, BENEDICT B (PHD)
Entity type:Individual
Prefix:DR
First Name:BENEDICT
Middle Name:B
Last Name:COOLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 E FOOTHILL BLVD
Mailing Address - Street 2:BEHAVIORAL RESOURCE CENTER
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-5230
Mailing Address - Country:US
Mailing Address - Phone:909-421-9495
Mailing Address - Fax:909-421-9494
Practice Address - Street 1:850 E FOOTHILL BLVD
Practice Address - Street 2:BEHAVIORAL RESOURCE CENTER
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5230
Practice Address - Country:US
Practice Address - Phone:909-421-9495
Practice Address - Fax:909-421-9494
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 4596103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical