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General NPI Number Information
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NPI Number | 1366165375
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Entity Type | Individual
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Provider Name | VICKI A COOPER
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Gender | Female
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Dates
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Enumeration Date | 09/23/2022
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Last Update Date | 09/23/2022
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Provider Practice Location Address
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Address Line | 12 1ST ST
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City | RIVERHEAD
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State | NY
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Zip | 11901-4602
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Country | US
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Telephone | 631-566-0427
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1831
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City | QUOGUE
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State | NY
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Zip | 11959-1831
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Country | US
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Telephone | 631-566-0427
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 093574
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License Number State | NY
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