Provider Demographics
NPI:1255409140
Name:COOK, ANGELA CAROL (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:CAROL
Last Name:COOK
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 BREEZERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-4211
Mailing Address - Country:US
Mailing Address - Phone:314-724-4355
Mailing Address - Fax:
Practice Address - Street 1:3675 W OUTER RD
Practice Address - Street 2:SUITE 203
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-5232
Practice Address - Country:US
Practice Address - Phone:314-898-0102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0045041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical