Provider Demographics
NPI:1073883054
Name:COOK, EUGENE ROBERT (LCSW)
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:ROBERT
Last Name:COOK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 EVELYN DR
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-9455
Mailing Address - Country:US
Mailing Address - Phone:719-431-1722
Mailing Address - Fax:
Practice Address - Street 1:555 EVELYN DR
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-9455
Practice Address - Country:US
Practice Address - Phone:719-431-1722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical