Provider Demographics
NPI:1194041442
Name:COOPER-GORDON, BARBARA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:
Last Name:COOPER-GORDON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E 75TH ST APT 22O
Mailing Address - Street 2:APT 7E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3378
Mailing Address - Country:US
Mailing Address - Phone:610-291-4670
Mailing Address - Fax:
Practice Address - Street 1:300 E 75TH ST APT 22O
Practice Address - Street 2:APT 7E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3378
Practice Address - Country:US
Practice Address - Phone:610-291-4670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2020-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077099-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical