Provider Demographics
NPI:1225168529
Name:COOKE, CARLA J (EDD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:J
Last Name:COOKE
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:773 CLIFFORD SALADIN ST
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-5670
Mailing Address - Country:US
Mailing Address - Phone:732-770-0351
Mailing Address - Fax:
Practice Address - Street 1:567 PARK AVE STE 101
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-1754
Practice Address - Country:US
Practice Address - Phone:908-322-3282
Practice Address - Fax:908-322-2517
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100403200103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3448688OtherAETNA PROVIDER ID
NJ316471OtherMHN PROVIDER ID
NJ598303000OtherMAGELLAN BCBS PROVIDER ID