Provider Demographics
NPI:1578848057
Name:COONLEY, DONNA M (LCSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:COONLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MEADOW LANE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208
Mailing Address - Country:US
Mailing Address - Phone:518-428-5506
Mailing Address - Fax:
Practice Address - Street 1:570 N PEARL ST
Practice Address - Street 2:
Practice Address - City:MENANDS
Practice Address - State:NY
Practice Address - Zip Code:12204-1659
Practice Address - Country:US
Practice Address - Phone:518-475-6808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR038171041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool