MEDICARE: ALYCIA COOKSEY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	084762	NY
2	104100000X	Social Worker	093568	NY

General Provider Information

NPI Number	:	1215482609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYCIA COOKSEY LCSW

Provider Business Mailing Address
First Line	:	43 DAVENPORT AVE
Second Line	:	SUITE MD
City	:	NEW ROCHELLE
State	:	NY
Zip	:	10805-3451
Country	:	US
Telephone Number	:	917-749-2420
Fax Number	:

Provider Business Practice Location Address
First Line	:	43 DAVENPORT AVE
Second Line	:	SUITE MD
City	:	NEW ROCHELLE
State	:	NY
Zip	:	10805-3451
Country	:	US
Telephone Number	:	917-749-2420
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2016
Last Update Date	:	09/27/2016

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