Provider Demographics
NPI:1588709901
Name:KOOPERSMITH, MERYL (MSSW LCSW)
Entity type:Individual
Prefix:MS
First Name:MERYL
Middle Name:
Last Name:KOOPERSMITH
Suffix:
Gender:F
Credentials:MSSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 E 79TH ST
Mailing Address - Street 2:
Mailing Address - City:NYC
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-535-3310
Mailing Address - Fax:212-535-2161
Practice Address - Street 1:175 E 79TH ST
Practice Address - Street 2:APT 8C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0565
Practice Address - Country:US
Practice Address - Phone:212-628-4938
Practice Address - Fax:212-535-2161
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0185461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical