Healthcare Provider Details

I. General information

NPI: 1437895471
Provider Name (Legal Business Name): MADELINE COOPER LCSW, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 5TH AVE STE 704-3051
NEW YORK NY
10001-4509
US

IV. Provider business mailing address

426 WESTPORT AVE # 1016
NORWALK CT
06851-4423
US

V. Phone/Fax

Practice location:
  • Phone: 917-719-4761
  • Fax:
Mailing address:
  • Phone: 917-719-4761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MADELINE COPER
Title or Position: PRESIDENT
Credential: LCSW
Phone: 917-719-4761