Provider Demographics
NPI:1548499262
Name:COOPER, CHARLES J JR (MAC, LMT RPP)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:J
Last Name:COOPER
Suffix:JR
Gender:M
Credentials:MAC, LMT RPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PARK ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-3910
Mailing Address - Country:US
Mailing Address - Phone:978-578-4595
Mailing Address - Fax:
Practice Address - Street 1:5 PARK ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-3910
Practice Address - Country:US
Practice Address - Phone:978-578-4595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238415171100000X
MAMT00132174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No174H00000XOther Service ProvidersHealth Educator