MEDICARE: MRS. GLAUKE COOIJMANS M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	004423	NY

General Provider Information

NPI Number	:	1326341629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GLAUKE COOIJMANS M.S.

Provider Business Mailing Address
First Line	:	71 W MAIN ST
Second Line	:	SUITE 1
City	:	OYSTER BAY
State	:	NY
Zip	:	11771-2258
Country	:	US
Telephone Number	:	516-558-7490
Fax Number	:

Provider Business Practice Location Address
First Line	:	71 W MAIN ST
Second Line	:	SUITE 1
City	:	OYSTER BAY
State	:	NY
Zip	:	11771-2258
Country	:	US
Telephone Number	:	516-558-7490
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2010
Last Update Date	:	12/09/2010

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