Provider Demographics
NPI:1912692591
Name:COOK, ROBERT F (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:F
Last Name:COOK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 791
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62903-0791
Mailing Address - Country:US
Mailing Address - Phone:618-203-4790
Mailing Address - Fax:618-305-8449
Practice Address - Street 1:604 EASTGATE ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-3304
Practice Address - Country:US
Practice Address - Phone:618-203-4790
Practice Address - Fax:618-305-8449
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.010209103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical