Provider Demographics
NPI:1720139181
Name:COOPER, JEANNETTE L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JEANNETTE
Middle Name:L
Last Name: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 1:1927 PARK ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11509-1340
Mailing Address - Country:US
Mailing Address - Phone:516-932-3706
Mailing Address - Fax:516-342-1897
Practice Address - Street 1:1097 OLD COUNTRY RD STE 105
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-6505
Practice Address - Country:US
Practice Address - Phone:516-932-3706
Practice Address - Fax:516-342-1897
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR328201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY032820OtherHIP
NY5610695OtherAETNA
NY7401003OtherGHI
NYP2534275OtherOXFORD
NY55975OtherVYTRA
NYN2356OtherEMPIRE BLUE CROSS BLUE SH
NY084701OtherVALUE OPTIONS
NY084701OtherVALUE OPTIONS