Provider Demographics
NPI:1821559055
Name:COOGAN, NICOLE L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:L
Last Name:COOGAN
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 1:50 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-2611
Mailing Address - Country:US
Mailing Address - Phone:631-513-1059
Mailing Address - Fax:
Practice Address - Street 1:196 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-2582
Practice Address - Country:US
Practice Address - Phone:631-513-1059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0881191041C0700X
NY1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical