1679566905 NPI number — MR. STEVEN I COOPER LCSW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679566905 NPI number — MR. STEVEN I COOPER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOPER
Provider First Name:
STEVEN
Provider Middle Name:
I
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679566905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6800 PITTSFORD PALMYRA RD STE 135
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRPORT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14450-3519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-235-7466
Provider Business Mailing Address Fax Number:
585-424-3614

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6800 PITTSFORD PALMYRA RD STE 135
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRPORT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14450-3519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-235-7466
Provider Business Practice Location Address Fax Number:
585-424-3614
Provider Enumeration Date:
08/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  R038329 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MDE76Z . This is a "PREFCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7331361 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P010038329 . This is a "BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 103743497 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2101527 . This is a "CIGNA BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".




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