Provider Demographics
NPI:1760631519
Name:COONLEY, GARY (MSW)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:COONLEY
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 1:782 PELHAM PKWY S
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-1142
Mailing Address - Country:US
Mailing Address - Phone:718-918-1700
Mailing Address - Fax:718-829-9640
Practice Address - Street 1:782 PELHAM PKWY S
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-1142
Practice Address - Country:US
Practice Address - Phone:718-918-1700
Practice Address - Fax:718-829-9640
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR032818-1101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor