Basic Information
| Provider Information | |||||||||
| NPI: | 1942447214 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOPERWASSER | ||||||||
| FirstName: | ANA | ||||||||
| MiddleName: | CELIA KELLER | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 665 PELHAM PKWY N | ||||||||
| Address2: | SUITE 402 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104678068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185198326 | ||||||||
| FaxNumber: | 7188818714 | ||||||||
| Practice Location | |||||||||
| Address1: | 665 PELHAM PKWY N | ||||||||
| Address2: | SUITE 402 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104678068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185198326 | ||||||||
| FaxNumber: | 7188818714 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2009 | ||||||||
| LastUpdateDate: | 01/08/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 00085038 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.