Provider Demographics
NPI:1376715524
Name:COOPER, SHELLION LATOYA (LMSW)
Entity type:Individual
Prefix:MISS
First Name:SHELLION
Middle Name:LATOYA
Last Name:COOPER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5629
Mailing Address - Country:US
Mailing Address - Phone:212-760-9822
Mailing Address - Fax:212-760-9826
Practice Address - Street 1:441 W 26TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5629
Practice Address - Country:US
Practice Address - Phone:212-760-9822
Practice Address - Fax:212-760-9826
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076728-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker