Anne Cooper, PSYD
Individual provider Active NPI Psychologist · Salem, MA
NPI 1588057012 · NPPES record last updated Feb 5, 2021
Key facts
- NPI
- 1588057012
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 11420 (MA)
- Practice address
- 265 Lafayette St Apt 3
Salem, MA 01970-5794 - Phone
- (978) 473-7961
- NPI assigned
- Mar 9, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2021 through Apr 1, 2027
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11420 | MA | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Anne Cooper Beazley LLC | Current |
Accepting new patients | |
| Riverside Community Care | Past | Accepting new patients | |
| Riverside Community Care, Inc. | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Psychologist | 103T00000X | 11420 | MA | Yes |
Addresses
Primary practice location
265 Lafayette St Apt 3
Salem, MA 01970-5794
Mailing address
265 Lafayette St Apt 3
Salem, MA 01970-5794
Phone (978) 473-7961
Other practice location 1
64 Eldredge St
Newton, MA 02458-2017
Phone (617) 969-4925
Other providers in Salem, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 5, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.