MEDICARE: EILEEN COOK CSW

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	104100000X	Social Worker	00001028	KY

General Provider Information

NPI Number	:	1649150277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EILEEN COOK CSW

Provider Business Mailing Address
First Line	:	3147 CUSTER DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-4020
Country	:	US
Telephone Number	:	859-447-0855
Fax Number	:	859-479-1090

Provider Business Practice Location Address
First Line	:	1002 S VIRGINIA ST STE 401
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240-3507
Country	:	US
Telephone Number	:	859-447-0855
Fax Number	:	859-479-1090

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

Provider Enumeration Date	:	09/04/2025
Last Update Date	:	09/04/2025

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