Provider Demographics
NPI:1811210446
Name:COOLEY, DYNEIL (LCSW, MA, CASAC)
Entity Type:Individual
Prefix:MS
First Name:DYNEIL
Middle Name:
Last Name:COOLEY
Suffix:
Gender:F
Credentials:LCSW, MA, CASAC
Other - Prefix:MS
Other - First Name:DYNEIL
Other - Middle Name:ROPER
Other - Last Name:COOLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, MA, CASAC
Mailing Address - Street 1:70 MORTON ST # 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-5700
Mailing Address - Country:US
Mailing Address - Phone:917-600-4233
Mailing Address - Fax:
Practice Address - Street 1:40 W 13TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7940
Practice Address - Country:US
Practice Address - Phone:917-600-4233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0811441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical