MEDICARE: SHIANNE AMARI COOKE LMHC

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	101YM0800X	Mental Health Counselor	018084	NY

General Provider Information

NPI Number	:	1639782477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIANNE AMARI COOKE LMHC

Provider Business Mailing Address
First Line	:	PO BOX 5103
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12205-0103
Country	:	US
Telephone Number	:	518-517-4535
Fax Number	:	518-240-4672

Provider Business Practice Location Address
First Line	:	125 WOLF RD STE 410
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12205-1263
Country	:	US
Telephone Number	:	518-517-4535
Fax Number	:	518-240-4672

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

Provider Enumeration Date	:	08/30/2020
Last Update Date	:	06/25/2026

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