Healthcare Provider Details

I. General information

NPI: 1821048992
Provider Name (Legal Business Name): ROBERT SYLVESTER COOK PSYCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MONTE LARGO DR NE
ALBUQUERQUE NM
87112-6318
US

IV. Provider business mailing address

1401 MONTE LARGO DR NE # 7101
ALBUQUERQUE NM
87112-6318
US

V. Phone/Fax

Practice location:
  • Phone: 806-786-2995
  • Fax:
Mailing address:
  • Phone: 806-786-2995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number26871
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-2023-0069
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: