Provider Demographics
NPI:1790822708
Name:PUCKERIN-COOPER, GAIL FRANKA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:FRANKA
Last Name:PUCKERIN-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 1:19838 POMPEII AVE APT 1D
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-1422
Mailing Address - Country:US
Mailing Address - Phone:347-307-6262
Mailing Address - Fax:
Practice Address - Street 1:41 E 11TH ST FL 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:347-307-6262
Practice Address - Fax:212-477-2040
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0716711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical