Provider Demographics
NPI:1932462207
Name:COOPER, CASSANDRA LOTOYA (MSED)
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:LOTOYA
Last Name:COOPER
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:MRS
Other - First Name:CASSANDRA
Other - Middle Name:LOTOYA
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:11030 172ND ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-3437
Mailing Address - Country:US
Mailing Address - Phone:718-809-6927
Mailing Address - Fax:718-206-1651
Practice Address - Street 1:11030 172ND ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-3437
Practice Address - Country:US
Practice Address - Phone:718-809-6927
Practice Address - Fax:718-206-1651
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY813870103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst