Provider Demographics
NPI:1467554055
Name:COOK, RANDOLPH CARY JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RANDOLPH
Middle Name:CARY
Last Name:COOK
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S BRYANT AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3402
Mailing Address - Country:US
Mailing Address - Phone:520-471-0004
Mailing Address - Fax:
Practice Address - Street 1:150 S BRYANT AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3402
Practice Address - Country:US
Practice Address - Phone:520-471-0004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904002673282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital