Provider Demographics
NPI:1528455193
Name:COOPER, KEZIA (LCSW-R)
Entity type:Individual
Prefix:
First Name:KEZIA
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:KEZIA
Other - Middle Name:
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:45 PINE GROVE AVE STE 217
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-5472
Mailing Address - Country:US
Mailing Address - Phone:845-481-0517
Mailing Address - Fax:
Practice Address - Street 1:45 PINE GROVE AVE STE 217
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5472
Practice Address - Country:US
Practice Address - Phone:845-481-0517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2025-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091559104100000X
NYR-0848231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR-084823OtherNYS OFFICE OF PROFESSIONS