Provider Demographics
NPI:1386779627
Name:COOK, BARBARA SUE (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:SUE
Last Name:COOK
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4144 N ARMENIA AVE
Mailing Address - Street 2:ATE.301
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6400
Mailing Address - Country:US
Mailing Address - Phone:813-875-0122
Mailing Address - Fax:813-875-0208
Practice Address - Street 1:4144 N ARMENIA AVE
Practice Address - Street 2:ATE.301
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6400
Practice Address - Country:US
Practice Address - Phone:813-875-0122
Practice Address - Fax:813-875-0208
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW71891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ058HAMedicare PIN