Provider Demographics
NPI:1891080792
Name:COOGAN, RACHEL DIENER (LMSW)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:DIENER
Last Name:COOGAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 HICKS ST APT 12M
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1642
Mailing Address - Country:US
Mailing Address - Phone:516-643-4468
Mailing Address - Fax:
Practice Address - Street 1:111 HICKS ST APT 12M
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1642
Practice Address - Country:US
Practice Address - Phone:516-643-4468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2013-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079410-1253Z00000X, 102L00000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No104100000XBehavioral Health & Social Service ProvidersSocial Worker