MEDICARE: MADELINE COOPER

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	104100000X	Social Worker	095467	NY
2	1041C0700X	Clinical Social Worker	087092	NY
3	1041C0700X	Clinical Social Worker	11888	CT

General Provider Information

NPI Number	:	1841693835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE COOPER

Provider Business Mailing Address
First Line	:	426 WESTPORT AVE # 1016
Second Line	:
City	:	NORWALK
State	:	CT
Zip	:	06851-4423
Country	:	US
Telephone Number	:	917-719-4761
Fax Number	:

Provider Business Practice Location Address
First Line	:	276 5TH AVENUE
Second Line	:	SUITE 704 - 3051
City	:	NEW YORK
State	:	NY
Zip	:	10001-5208
Country	:	US
Telephone Number	:	917-719-4761
Fax Number	:

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

Provider Enumeration Date	:	10/03/2014
Last Update Date	:	12/10/2021

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Directions to “ MADELINE COOPER ” Practice Location

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