MEDICARE: CASAANDRA COOK

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

General Provider Information

NPI Number	:	1831585371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASAANDRA COOK

Provider Business Mailing Address
First Line	:	927 S GOLDWYN AVE
Second Line	:	SUTIE 219
City	:	ORLANDO
State	:	FL
Zip	:	32805-4324
Country	:	US
Telephone Number	:	407-985-4236
Fax Number	:	407-250-3445

Provider Business Practice Location Address
First Line	:	927 S GOLDWYN AVE
Second Line	:	SUTIE 219
City	:	ORLANDO
State	:	FL
Zip	:	32805-4324
Country	:	US
Telephone Number	:	407-985-4236
Fax Number	:	407-250-3445

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

Provider Enumeration Date	:	04/11/2015
Last Update Date	:	04/11/2015

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Directions to “ CASAANDRA COOK ” Practice Location

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