MEDICARE: DONNA M COONLEY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041S0200X	School Social Worker	R03817	NY

General Provider Information

NPI Number	:	1578848057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA M COONLEY LCSW

Provider Business Mailing Address
First Line	:	11 MEADOW LANE
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12208
Country	:	US
Telephone Number	:	518-428-5506
Fax Number	:

Provider Business Practice Location Address
First Line	:	570 N PEARL ST
Second Line	:
City	:	MENANDS
State	:	NY
Zip	:	12204-1659
Country	:	US
Telephone Number	:	518-475-6808
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2011
Last Update Date	:	10/17/2011

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