Healthcare Provider Details

I. General information

NPI: 1790822708
Provider Name (Legal Business Name): GAIL FRANKA PUCKERIN-COOPER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 E 11TH ST FL 4
NEW YORK NY
10003
US

IV. Provider business mailing address

19838 POMPEII AVE APT 1D
HOLLIS NY
11423-1422
US

V. Phone/Fax

Practice location:
  • Phone: 347-307-6262
  • Fax: 212-477-2040
Mailing address:
  • Phone: 347-307-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number071671
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: