MEDICARE: ASHLEY COOLEY

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	102458-1	NY

General Provider Information

NPI Number	:	1952872327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY COOLEY

Provider Business Mailing Address
First Line	:	21841 99TH AVE
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11429-1205
Country	:	US
Telephone Number	:	718-674-8484
Fax Number	:	718-465-7083

Provider Business Practice Location Address
First Line	:	21841 99TH AVE
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11429-1205
Country	:	US
Telephone Number	:	718-674-8484
Fax Number	:	718-465-7083

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

Provider Enumeration Date	:	12/11/2018
Last Update Date	:	12/11/2018

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Directions to “ ASHLEY COOLEY ” Practice Location

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