Provider Demographics
NPI:1417181520
Name:COONEY, NOREEN LEA (LICSW)
Entity type:Individual
Prefix:
First Name:NOREEN
Middle Name:LEA
Last Name:COONEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:NOREEN
Other - Middle Name:LEA
Other - Last Name:WEFEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:502 FREMONT ST E
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-2810
Mailing Address - Country:US
Mailing Address - Phone:507-645-8511
Mailing Address - Fax:
Practice Address - Street 1:502 FREMONT ST E
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2810
Practice Address - Country:US
Practice Address - Phone:507-645-8511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN095891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical