Provider Demographics
NPI:1225400666
Name:JACKSON-COOPER, KAMILYAH (LCSW)
Entity Type:Individual
Prefix:
First Name:KAMILYAH
Middle Name:
Last Name:JACKSON-COOPER
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 1:50 N 5TH ST APT E7A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-3317
Mailing Address - Country:US
Mailing Address - Phone:302-897-8581
Mailing Address - Fax:
Practice Address - Street 1:124 E 40TH ST RM 901
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1766
Practice Address - Country:US
Practice Address - Phone:347-352-1232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0885821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical