Basic Information
| Provider Information | |||||||||
| NPI: | 1922366921 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOPER | ||||||||
| FirstName: | AARON | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 203 HURON ST APT 2F | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112221998 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016026332 | ||||||||
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| Practice Location | |||||||||
| Address1: | 24302 NORTHERN BLVD | ||||||||
| Address2: | |||||||||
| City: | DOUGLASTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113621150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184236200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2012 | ||||||||
| LastUpdateDate: | 07/16/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 0794941 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.