Provider Demographics
NPI:1104047349
Name:COOKE, ROBERT HOWARD III
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:HOWARD
Last Name:COOKE
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 GOLDEN MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-9393
Mailing Address - Country:US
Mailing Address - Phone:609-567-1713
Mailing Address - Fax:609-567-1713
Practice Address - Street 1:118 GOLDEN MEADOW LN
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-9393
Practice Address - Country:US
Practice Address - Phone:609-567-1713
Practice Address - Fax:609-567-1713
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst