Provider Demographics
NPI:1275662660
Name:COOLEY, ERIKA MALM (LCSW)
Entity type:Individual
Prefix:MS
First Name:ERIKA
Middle Name:MALM
Last Name:COOLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ERIKA
Other - Middle Name:TYLER
Other - Last Name:MALM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:156 5TH AVE
Mailing Address - Street 2:SUITE 1223
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-7002
Mailing Address - Country:US
Mailing Address - Phone:212-461-4249
Mailing Address - Fax:
Practice Address - Street 1:156 5TH AVE
Practice Address - Street 2:SUITE 1223
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7002
Practice Address - Country:US
Practice Address - Phone:212-461-4249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0773321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABR032ZMedicare PIN