Provider Demographics
NPI:1629393210
Name:COOK, SHARON (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1110 BOSTON RD
Mailing Address - Street 2:LYFE PROGRAM
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-5375
Mailing Address - Country:US
Mailing Address - Phone:646-515-3848
Mailing Address - Fax:
Practice Address - Street 1:1110 BOSTON RD
Practice Address - Street 2:LYFE PROGRAM
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-5375
Practice Address - Country:US
Practice Address - Phone:646-515-3848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR047538-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical