Provider Demographics
NPI:1215300272
Name:HAMPTON, COSETTE ANNETTE (BA)
Entity type:Individual
Prefix:MISS
First Name:COSETTE
Middle Name:ANNETTE
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MISS
Other - First Name:COSETTE
Other - Middle Name:ANNETTE
Other - Last Name:HAMPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:530 WEST 187 STREET
Mailing Address - Street 2:JUST ONE BREAK INC
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10033-1437
Mailing Address - Country:US
Mailing Address - Phone:609-347-6256
Mailing Address - Fax:
Practice Address - Street 1:530 WEST 187 STREET
Practice Address - Street 2:JUST ONE BREAK INC
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10033-1437
Practice Address - Country:US
Practice Address - Phone:609-347-6256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)