Individual
MR. BRUCE L COOPERSMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
146 PIKE ST, PORT JERVIS, NY 12771-1808
(845) 858-1456
(845) 858-1459
Mailing address
146 PIKE ST, PORT JERVIS, NY 12771-1808
(845) 858-1456
(845) 858-1459
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
R034362-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00542503
—
NY
Enumeration date
10/12/2005
Last updated
02/28/2014
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