Healthcare Provider Details

I. General information

NPI: 1609417575
Provider Name (Legal Business Name): XENIA C COOLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 PARK AVE
NEW YORK NY
10029-3810
US

IV. Provider business mailing address

1475 PARK AVE
NEW YORK NY
10029-3810
US

V. Phone/Fax

Practice location:
  • Phone: 212-426-3400
  • Fax:
Mailing address:
  • Phone: 212-426-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number124314
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: