Provider Demographics
NPI:1154643880
Name:COCOLI, ENIKA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ENIKA
Middle Name:
Last Name:COCOLI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8728 23RD ST NE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-6476
Mailing Address - Country:US
Mailing Address - Phone:425-789-1415
Mailing Address - Fax:
Practice Address - Street 1:1106 COLUMBIA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4335
Practice Address - Country:US
Practice Address - Phone:360-653-0374
Practice Address - Fax:360-658-0219
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 3893103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical