MEDICARE: MS. JEANNETTE L. COOPER LCSW

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	1041C0700X	Clinical Social Worker	R32820	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	032820	OTHER	NY	HIP
2	5610695	OTHER	NY	AETNA
3	7401003	OTHER	NY	GHI
4	P2534275	OTHER	NY	OXFORD
5	55975	OTHER	NY	VYTRA
6	N2356	OTHER	NY	EMPIRE BLUE CROSS BLUE SH
7	084701	OTHER	NY	VALUE OPTIONS

General Provider Information

NPI Number	:	1720139181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JEANNETTE L. COOPER LCSW

Provider Business Mailing Address
First Line	:	1927 PARK ST
Second Line	:
City	:	ATLANTIC BEACH
State	:	NY
Zip	:	11509-1340
Country	:	US
Telephone Number	:	516-932-3706
Fax Number	:	516-342-1897

Provider Business Practice Location Address
First Line	:	1097 OLD COUNTRY RD STE 105
Second Line	:
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-6505
Country	:	US
Telephone Number	:	516-932-3706
Fax Number	:	516-342-1897

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

Provider Enumeration Date	:	01/14/2007
Last Update Date	:	01/17/2019

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Directions to “ MS. JEANNETTE L. COOPER LCSW” Practice Location

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