Provider Demographics
NPI:1386668606
Name:KOOPERMAN, DAVID (MSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:KOOPERMAN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5134 CURRY RD
Mailing Address - Street 2:
Mailing Address - City:TRUMANSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14886-9518
Mailing Address - Country:US
Mailing Address - Phone:607-387-3128
Mailing Address - Fax:607-272-1014
Practice Address - Street 1:5134 CURRY RD
Practice Address - Street 2:
Practice Address - City:TRUMANSBURG
Practice Address - State:NY
Practice Address - Zip Code:14886-9518
Practice Address - Country:US
Practice Address - Phone:607-272-1014
Practice Address - Fax:607-272-3547
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR018186-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01482080Medicaid
NY117344OtherBHN
NY1P095314OtherMAGELLEN
NY4380478OtherAETNA
NY101383000OtherMBC
NY028320OtherVALUE
NY107541OtherTRICARE
NY7403612OtherGHI