Provider Demographics
NPI:1790050524
Name:COOPER, REBECCA (LCSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:COOPER
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 1:7 DANA CT
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-2311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:435 NEW KARNER RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-3833
Practice Address - Country:US
Practice Address - Phone:518-456-2361
Practice Address - Fax:518-456-2361
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2018-06-18
Deactivation Date:2018-06-18
Deactivation Code:
Reactivation Date:2018-06-18
Provider Licenses
StateLicense IDTaxonomies
NYRO53436-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical