Provider Demographics
NPI:1578076766
Name:COOK, KELLY E (MSW)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:E
Last Name:COOK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 SILLS LN
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-4963
Mailing Address - Country:US
Mailing Address - Phone:516-445-2686
Mailing Address - Fax:
Practice Address - Street 1:506 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-2776
Practice Address - Country:US
Practice Address - Phone:484-693-0856
Practice Address - Fax:484-696-1634
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1OtherPRIVATE/SELF PAY