Provider Demographics
NPI:1619041142
Name:COONEY, JAMES P (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:P
Last Name:COONEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 POST ROAD WEST
Mailing Address - Street 2:
Mailing Address - City:WEST PORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-4650
Mailing Address - Country:US
Mailing Address - Phone:203-854-5749
Mailing Address - Fax:203-854-5764
Practice Address - Street 1:181 POST ROAD WEST
Practice Address - Street 2:
Practice Address - City:WEST PORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4650
Practice Address - Country:US
Practice Address - Phone:203-854-5749
Practice Address - Fax:203-854-5764
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0041171041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT800002001Medicare ID - Type Unspecified