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NYC Service Coordination Forms

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Work With Us!

We are currently looking for SLP, OT, PT, ABA, Teachers, Psychologists, Social Workers, and Service Coordinators. All therapists are required to have a Department of Health approval letter to work as independent contractors.

Cooper Kids Therapy Associates does not discriminate against employees or applicants for employment on the basis of age, race, color, religions, sex, gender, sexual orientation, alienage or citizenship status, marital status, disability, national origin, genetic disposition, genetic carrier status, military or veteran status or any other basis upon which discrimination against employees or applicants for employment is prohibited under any federal, state or local law.

Submit your resume and information below and we’ll reach out to you as relevant job openings come available!

First Name *

Last Name *

Phone Number *

Email Address *

Applying For *

Resume *

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Copy of New York State Department of Health Early Intervention Approval Letter *

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If you do not have your DOH EI Approval Letter, call DOH at (518) 473-7016 and tell them you’d like to become an Approved EI Provider. This process typically takes a few weeks.

Message *

Additional Documents

To expedite the onboarding process, you may choose to upload any/all of the following documents (you can access many of these forms in New Therapist Forms under our website’s Therapist Forms section).

Therapist Form

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Business Card

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Driver’s License (Front)

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Driver’s License (Back)

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Social Security Card

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Reference Letter #1

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Reference Letter #2

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Therapist License

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(Required for ST, OT, PT, SW, etc.)

Certification

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(Required for Special Education)

COVID Vaccination Card

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Tier 1 Certificate

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(Required for Nassau / Suffolk County ABA therapists)

Medical / TB Screening

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(Dated within the past 12 months with results of PPD test and Immunization History)

Professional Liability Insurance

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(You can obtain this upon taking your first case by calling Educators Liability Insurance at (800) 821-7303.)

List of In-Services

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(Upload certificates or provide a list of those you have attended within the last year totaling at least 10 hours, from at least 2 different workshops/trainings)

Child Abuse Course

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(Proof of attendance; may be listed on your college transcript; course offered by Coalition Domestic Violence - Garden City (516) 747-2966 or available online at http://www.nysmandatedreporter.org)

Independent Contract

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(Sign & date the first and last pages)

CKTA Policy & Procedure

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(Sign page 2)

Service Areas Form

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(Highlight / select the areas on the form that you will provide services for)

NPI #(If you are a licensed provider; you can visit https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart to obtain an NPI #, or call (800) 465-3203)

Incorporation Information

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(If you are incorporated, you must submit paperwork including your Incorporated NPI #, Employer Identification Number (EIN), and Incorporated Name)

For Therapists

Therapist Emails

Progress Reports

Therapist Compliance

Therapist Forms

DO NOT DELETE

Nassau County EI Forms

Suffolk County EI Forms

Nassau and Suffolk Preschool Forms

NYCEI Forms

Converting ICD-9 Codes to ICD-10 Codes

Other

DO NOT DELETE

New York State Medicaid Enrollment

State Central Register Clearance Forms

Corporate Medicaid Compliance

Free Professional Development Online Trainings

New Therapist Forms

Enterclaims Training

NYC Service Coordination Forms

Work With Us!

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Address

2 Roosevelt Avenue, Suite 300 Syosset, NY 11791

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