Provider Demographics
NPI:1134337595
Name:OSORIO COOKSY, AMANDA N (LMSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:N
Last Name:OSORIO COOKSY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:N
Other - Last Name:GERWOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:9387 VINE AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-1666
Mailing Address - Country:US
Mailing Address - Phone:810-625-6724
Mailing Address - Fax:
Practice Address - Street 1:835 MASON ST STE A135
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2231
Practice Address - Country:US
Practice Address - Phone:248-861-9861
Practice Address - Fax:866-522-9110
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010934131041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801093413OtherMASTER'S SOCIAL WORKER CLINICAL LICENSE