Individual
DR. COOPER WOODARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
86 MOUNT HOPE AVE, PROVIDENCE, RI 02906-1648
(401) 274-6310
Mailing address
56 EDGEHILL RD, PROVIDENCE, RI 02906-2713
(401) 274-6310
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
103TA0700X
Adult Development & Aging Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC0700X
Clinical Psychologist
PS00793
RI
103TC1900X
Counseling Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
103TS0200X
School Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PS00793
STATE OF RI LICENSE
RI
Enumeration date
11/05/2007
Last updated
11/05/2007
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