Provider Demographics
NPI:1861579211
Name:COOPER, BETH M (PHD)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:M
Last Name:COOPER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:BETH
Other - Middle Name:M
Other - Last Name:COOPER HILBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:381 HUBBARD STREET
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033
Mailing Address - Country:US
Mailing Address - Phone:860-657-0683
Mailing Address - Fax:860-657-4686
Practice Address - Street 1:381 HUBBARD STREET
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033
Practice Address - Country:US
Practice Address - Phone:860-657-0683
Practice Address - Fax:860-657-4686
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT880103T00000X
CT000272106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist