Provider Demographics
NPI:1477167815
Name:COOKE, CYDARIA LASHON (MBA, MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CYDARIA
Middle Name:LASHON
Last Name:COOKE
Suffix:
Gender:F
Credentials:MBA, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7909 PRESERVATION DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-9553
Mailing Address - Country:US
Mailing Address - Phone:317-258-9336
Mailing Address - Fax:
Practice Address - Street 1:7909 PRESERVATION DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-9553
Practice Address - Country:US
Practice Address - Phone:317-258-9336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34008930A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical