Provider Demographics
NPI:1255688172
Name:COOKE, EDITH ALEXANDER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EDITH
Middle Name:ALEXANDER
Last Name:COOKE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5016 PARKWAY CALABASAS SUITE #215
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-3927
Mailing Address - Country:US
Mailing Address - Phone:310-497-1404
Mailing Address - Fax:
Practice Address - Street 1:5016 PARKWAY CALABASAS SUITE 215
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-3927
Practice Address - Country:US
Practice Address - Phone:310-497-1404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2015-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16947103TC0700X
HIPSY1122103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical