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General NPI Number Information
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NPI Number | 1043543119
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Entity Type | Individual
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Provider Name | STACI COOK-WHITE M.S.W., L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 09/08/2009
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Last Update Date | 09/08/2009
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Provider Practice Location Address
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Address Line | 2630 E CHESTNUT AVE
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City | VINELAND
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State | NJ
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Zip | 08361-8400
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Country | US
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Telephone | 856-696-5690
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Fax | 856-696-4799
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Provider Business Mailing Address
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Address Line | 17 HOLDING RD
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City | BRIDGETON
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State | NJ
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Zip | 08302-5690
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Country | US
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Telephone | 856-696-5690
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Fax | 856-696-4799
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05390800
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License Number State | NJ
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