Provider Demographics
NPI:1326418583
Name:JANE COOKE,LCSW,ACSW,LLC
Entity Type:Organization
Organization Name:JANE COOKE,LCSW,ACSW,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW,ACSW
Authorized Official - Phone:215-280-7716
Mailing Address - Street 1:107 HARDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-2035
Mailing Address - Country:US
Mailing Address - Phone:215-280-7716
Mailing Address - Fax:215-996-0520
Practice Address - Street 1:100 S MAIN ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-2847
Practice Address - Country:US
Practice Address - Phone:215-280-7716
Practice Address - Fax:215-996-0520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0140981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA055300GMHMedicare PIN