Provider Demographics
NPI:1396851796
Name:KOOL, EVA ANNA (LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:EVA
Middle Name:ANNA
Last Name:KOOL
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CARDINAL CT
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-2731
Mailing Address - Country:US
Mailing Address - Phone:518-877-8812
Mailing Address - Fax:518-877-8812
Practice Address - Street 1:315 USHERS RD
Practice Address - Street 2:
Practice Address - City:BALLSTON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12019-1547
Practice Address - Country:US
Practice Address - Phone:518-877-8812
Practice Address - Fax:518-877-8812
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR061422101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02134807Medicaid
NY02134807Medicaid
19707Medicare UPIN