Provider Demographics
NPI:1588938278
Name:COOL, SHANDA ALISON (LCSW)
Entity type:Individual
Prefix:
First Name:SHANDA
Middle Name:ALISON
Last Name:COOL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHANDA
Other - Middle Name:
Other - Last Name:BERRIOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1927
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-1927
Mailing Address - Country:US
Mailing Address - Phone:502-637-4361
Mailing Address - Fax:
Practice Address - Street 1:841 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1014
Practice Address - Country:US
Practice Address - Phone:502-561-1051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2544461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical