Provider Demographics
NPI:1417391939
Name:COCKERHAM, ANTOINETTE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANTOINETTE
Middle Name:
Last Name:COCKERHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 EAST 92ND STREET, 3RD FLOOR
Mailing Address - Street 2:SPENCE-CHAPIN SERVICES TO FAMILIES & CHILDREN
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-6804
Mailing Address - Country:US
Mailing Address - Phone:212-360-0252
Mailing Address - Fax:212-360-0282
Practice Address - Street 1:410 EAST 92ND STREET, 3RD FLOOR
Practice Address - Street 2:SPENCE-CHAPIN SERVICES TO FAMILIES & CHILDREN
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-6804
Practice Address - Country:US
Practice Address - Phone:212-360-0252
Practice Address - Fax:212-360-0282
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072258-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical