Provider Demographics
NPI:1144814708
Name:COOK, WAVERLY JR (MS)
Entity type:Individual
Prefix:
First Name:WAVERLY
Middle Name:
Last Name:COOK
Suffix:JR
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:TRAINER
Mailing Address - State:PA
Mailing Address - Zip Code:19061-5310
Mailing Address - Country:US
Mailing Address - Phone:267-690-5293
Mailing Address - Fax:
Practice Address - Street 1:3811 W 13TH ST
Practice Address - Street 2:
Practice Address - City:TRAINER
Practice Address - State:PA
Practice Address - Zip Code:19061-5310
Practice Address - Country:US
Practice Address - Phone:267-690-5293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst