=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023238383
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIANNE FRANCES COOK LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 220 BAGLEY SUITE 1100
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-961-7990
-----------------------------------------------------
Fax | 313-961-1047
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28069 QUAIL HOLLOW RD
-----------------------------------------------------
City | FARMINGTON HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48331-3304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-553-2409
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 6801017631
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------