Active NPI
Kerry Cooper, CASAC
- Addiction (Substance Use Disorder) Counselor
- Bronx, NY
National Provider Identifier
1710056726
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- Practice address
- 3584 Jerome Ave
Bronx, NY 10467-1006 - Phone
- (718) 653-1537
- Fax
- (718) 882-1426
- NPI assigned
- Nov 6, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 12174 | NY | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | NY | Primary |
Addresses
Primary practice location
3584 Jerome Ave
Bronx, NY 10467-1006
Mailing address
PO Box 31094
Hartford, CT 06154-0001
Phone (518) 952-8140
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01420795 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12174 | NY | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1236902400000",
"number": "1710056726",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 31094",
"city": "HARTFORD",
"state": "CT",
"postal_code": "061540001",
"telephone_number": "518-952-8140",
"fax_number": "518-952-8287"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3584 JEROME AVE",
"city": "BRONX",
"state": "NY",
"postal_code": "104671006",
"telephone_number": "718-653-1537",
"fax_number": "718-882-1426"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COOPER",
"first_name": "KERRY",
"name_prefix": "Mr.",
"credential": "CASAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-06",
"last_updated": "2009-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NY",
"license": "12174",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NY",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01420795",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.