| Doctor Name: | DR. JESSE M COOPER |
| NPI Number: | 1104111970 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | |
| Business Practice Address: | 900 Haddon Ave Ste 234 Collingswood, NJ - 081082111 |
| Business Phone Number: | 8568585830 |
| Business Fax Number: | 8568585833 |
| Mailing Address: | 900 Haddon Ave Ste 234, COLLINGSWOOD |
| State: | NJ |
| Postal Code: | 081082111 |
| Phone Number: | 8568585830 |
| Fax Number: | 8568585833 |
| NPI Enumeration Date: | 06/09/2011 |
| NPI Last Update Date: | 06/09/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |