Healthcare Provider Details

I. General information

NPI: 1114734845
Provider Name (Legal Business Name): MAKENZI COOLEY LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8009 78TH AVE
GLENDALE NY
11385-7626
US

IV. Provider business mailing address

8009 78TH AVE
GLENDALE NY
11385-7626
US

V. Phone/Fax

Practice location:
  • Phone: 347-255-2755
  • Fax:
Mailing address:
  • Phone: 347-255-2755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number002687
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberF.2600596
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: