MEDICARE: AMANDA N OSORIO COOKSY LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801093413	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6801093413	OTHER	MI	MASTER'S SOCIAL WORKER CLINICAL LICENSE

General Provider Information

NPI Number	:	1134337595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA N OSORIO COOKSY LMSW

Provider Business Mailing Address
First Line	:	9387 VINE AVE
Second Line	:
City	:	ALLEN PARK
State	:	MI
Zip	:	48101-1666
Country	:	US
Telephone Number	:	810-625-6724
Fax Number	:

Provider Business Practice Location Address
First Line	:	835 MASON ST STE A135
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-2231
Country	:	US
Telephone Number	:	248-861-9861
Fax Number	:	866-522-9110

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	11/01/2024

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