Provider Demographics
NPI:1710235841
Name:COOK, EMBER IAN (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:EMBER
Middle Name:IAN
Last Name:COOK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:EMBER
Other - Middle Name:IAN
Other - Last Name:COREDINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:2140 SHATTUCK AVE STE 405
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1214
Mailing Address - Country:US
Mailing Address - Phone:510-206-0599
Mailing Address - Fax:
Practice Address - Street 1:2140 SHATTUCK AVE STE 405
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1214
Practice Address - Country:US
Practice Address - Phone:510-206-0599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29064103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical