Provider Information for 1700040623
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KENNETH ROBERT COOPER LMSW
Sex: Male
NPI: 1700040623
Last Updated: 2011-09-09
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1700040623 | ||||||||
| Enumeration Date | 2008-07-10 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 211 CHURCH ST SARATOGA SPRINGS, NY 12866-1003 United States Phone: 518-584-9030 | Fax:518-581-1709 | ||||||||
| Primary Practice Address | 211 CHURCH ST SARATOGA SPRINGS, NY 12866-1003 United States Phone: 518-584-9030 | Fax:518-581-1709 | ||||||||
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