Individual
LARETTE DENISE COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
4277 65TH PL, WOODSIDE, NY 11377-5054
(516) 755-7878
(718) 334-0057
Mailing address
17860 WEXFORD TER APT 1H, JAMAICA, NY 11432-3018
(917) 312-2620
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
418588239
DRIVER'S LICENSE
NY
Enumeration date
11/14/2019
Last updated
11/14/2019
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