Provider Demographics
NPI:1316569486
Name:COOPER, KAYLA ARIELLE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:ARIELLE
Last Name:COOPER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WANSER PL
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-3134
Mailing Address - Country:US
Mailing Address - Phone:516-384-7049
Mailing Address - Fax:
Practice Address - Street 1:14 WANSER PL
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-3134
Practice Address - Country:US
Practice Address - Phone:516-384-7049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY096808-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker