Healthcare Provider Details

I. General information

NPI: 1639782477
Provider Name (Legal Business Name): SHIANNE AMARI COOKE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2020
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 WOLF RD STE 410
ALBANY NY
12205-1263
US

IV. Provider business mailing address

PO BOX 5103
ALBANY NY
12205-0103
US

V. Phone/Fax

Practice location:
  • Phone: 518-517-4535
  • Fax: 518-240-4672
Mailing address:
  • Phone: 518-517-4535
  • Fax: 518-240-4672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number018084
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: