Provider Demographics
NPI:1730563701
Name:COOPER, JOAN BETH (PHD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:BETH
Last Name:COOPER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 N WASHINGTON AVE
Mailing Address - Street 2:SUITE 202 WEST
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-2448
Mailing Address - Country:US
Mailing Address - Phone:856-866-9888
Mailing Address - Fax:
Practice Address - Street 1:302 N WASHINGTON AVE
Practice Address - Street 2:SUITE 202 WEST
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-2448
Practice Address - Country:US
Practice Address - Phone:856-866-9888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-19
Last Update Date:2015-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2997103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical