Provider Demographics
NPI:1841356730
Name:COOK, ANN SHEILA (LCSW)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:SHEILA
Last Name:COOK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4212 ROBIN HOOD RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-5827
Mailing Address - Country:US
Mailing Address - Phone:904-384-4977
Mailing Address - Fax:
Practice Address - Street 1:4212 ROBIN HOOD RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-5827
Practice Address - Country:US
Practice Address - Phone:904-384-4977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0009451041C0700X
NY073314-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical