1548455082 NPI number — MS. PHILLIS KAY COOKE LCSWC BCD

Table of content: MS. PHILLIS KAY COOKE LCSWC BCD (NPI 1548455082)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548455082 NPI number — MS. PHILLIS KAY COOKE LCSWC BCD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOKE
Provider First Name:
PHILLIS
Provider Middle Name:
KAY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSWC BCD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COOKE
Provider Other First Name:
PHILLIS
Provider Other Middle Name:
WALLS
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSWC BCD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1548455082
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
913 S BELGRADE ROAD
Provider Second Line Business Mailing Address:
PHILLIS COOKE
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20902-3252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-649-1415
Provider Business Mailing Address Fax Number:
301-649-2127

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
913 S BELGRADE ROAD
Provider Second Line Business Practice Location Address:
PHILLIS COOKE
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20902-3252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-649-1415
Provider Business Practice Location Address Fax Number:
301-649-2127
Provider Enumeration Date:
09/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  01017 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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