Provider Demographics
NPI:1306033766
Name:COOPER, DENISE MICHELLE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:MICHELLE
Last Name:COOPER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:MICHELLE
Other - Last Name:KONZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:46 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-4518
Mailing Address - Country:US
Mailing Address - Phone:845-471-6004
Mailing Address - Fax:845-471-7099
Practice Address - Street 1:46 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-4518
Practice Address - Country:US
Practice Address - Phone:845-471-6004
Practice Address - Fax:845-471-7099
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075355-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker