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General NPI Number Information
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NPI Number | 1326418583
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Entity Type | Organization
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Legal Business Name | JANE COOKE,LCSW,ACSW,LLC
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Dates
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Enumeration Date | 09/30/2015
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Last Update Date | 09/30/2015
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Provider Practice Location Address
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Address Line | 100 S MAIN ST SUITE 2A
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City | NORTH WALES
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State | PA
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Zip | 19454-2847
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Country | US
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Telephone | 215-280-7716
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Fax | 215-996-0520
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Provider Business Mailing Address
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Address Line | 107 HARDWOOD CT
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City | CHALFONT
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State | PA
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Zip | 18914-2035
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Country | US
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Telephone | 215-280-7716
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Fax | 215-996-0520
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | JANE COOKE
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Credential | LCSW,ACSW
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Telephone | 215-280-7716
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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 | CW014098
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License Number State | PA
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