Provider Demographics
NPI:1780896886
Name:COOKE, ROBERT K (LICSW)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:K
Last Name:COOKE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-1942
Mailing Address - Country:US
Mailing Address - Phone:508-393-9899
Mailing Address - Fax:508-393-9480
Practice Address - Street 1:20 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-1942
Practice Address - Country:US
Practice Address - Phone:508-393-9899
Practice Address - Fax:508-393-9480
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10307611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP21294Medicare ID - Type Unspecified