Individual
LAKESHIA COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
550 BROADWAY, AMITYVILLE, NY 11701-2148
(631) 842-1639
(631) 842-0165
Mailing address
550 BROADWAY, AMITYVILLE, NY 11701-2148
(631) 842-1639
(631) 842-0165
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
00287717
NY
Other
Enumeration date
05/19/2015
Last updated
05/19/2015
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