Provider Demographics
NPI:1811679608
Name:COOPER, KRISTEN GROWNEY (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:GROWNEY
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 1:72 HEATHER DALE CHASE
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14467-9553
Mailing Address - Country:US
Mailing Address - Phone:585-615-6609
Mailing Address - Fax:
Practice Address - Street 1:1655 ELMWOOD AVE STE 222
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-3426
Practice Address - Country:US
Practice Address - Phone:585-210-2344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0909301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical