Provider Demographics
NPI:1336033828
Name:COOLEY, JAIRUS
Entity type:Individual
Prefix:
First Name:JAIRUS
Middle Name:
Last Name:COOLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 NORTH AVE APT TX
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-2641
Mailing Address - Country:US
Mailing Address - Phone:917-480-9929
Mailing Address - Fax:
Practice Address - Street 1:1255 NORTH AVE APT TX
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-2641
Practice Address - Country:US
Practice Address - Phone:917-480-9929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-07
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst