Healthcare Provider Details

I. General information

NPI: 1720139181
Provider Name (Legal Business Name): JEANNETTE L. COOPER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2007
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1097 OLD COUNTRY RD STE 105
PLAINVIEW NY
11803-6505
US

IV. Provider business mailing address

1927 PARK ST
ATLANTIC BEACH NY
11509-1340
US

V. Phone/Fax

Practice location:
  • Phone: 516-932-3706
  • Fax: 516-342-1897
Mailing address:
  • Phone: 516-932-3706
  • Fax: 516-342-1897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR32820
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier032820
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerHIP
# 2
Identifier5610695
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerAETNA
# 3
Identifier7401003
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerGHI
# 4
IdentifierP2534275
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerOXFORD
# 5
Identifier55975
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerVYTRA
# 6
IdentifierN2356
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerEMPIRE BLUE CROSS BLUE SH
# 7
Identifier084701
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerVALUE OPTIONS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: