Provider Demographics
NPI:1992964803
Name:COOKE-CHANNER, LORA FAYE (MSW)
Entity type:Individual
Prefix:MRS
First Name:LORA
Middle Name:FAYE
Last Name:COOKE-CHANNER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:LORA
Other - Middle Name:FAYE
Other - Last Name:COOKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:9707 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3609
Mailing Address - Country:US
Mailing Address - Phone:951-358-6858
Mailing Address - Fax:951-687-3478
Practice Address - Street 1:9707 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3609
Practice Address - Country:US
Practice Address - Phone:951-358-6858
Practice Address - Fax:951-687-3478
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW277131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical