Provider Demographics
NPI:1811336852
Name:DR. CARLA J. COOKE, LLC
Entity type:Organization
Organization Name:DR. CARLA J. COOKE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:908-322-3282
Mailing Address - Street 1:567 PARK AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-1754
Mailing Address - Country:US
Mailing Address - Phone:908-322-3282
Mailing Address - Fax:
Practice Address - Street 1:567 PARK AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-1754
Practice Address - Country:US
Practice Address - Phone:908-322-3282
Practice Address - Fax:908-322-2517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00403200103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty