MEDICARE: MS. ELIZABETH LYNN COOKE 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	104100000X	Social Worker	R043559	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	272281	OTHER	NY	PROVIDER

General Provider Information

NPI Number	:	1992876593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH LYNN COOKE LCSW

Provider Business Mailing Address
First Line	:	5300 HOLLAND ST
Second Line	:
City	:	ARVADA
State	:	CO
Zip	:	80002-2963
Country	:	US
Telephone Number	:	212-741-6551
Fax Number	:	866-869-5563

Provider Business Practice Location Address
First Line	:	5300 HOLLAND ST
Second Line	:
City	:	ARVADA
State	:	CO
Zip	:	80002-2963
Country	:	US
Telephone Number	:	212-741-6551
Fax Number	:	866-869-5563

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	09/29/2010

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