Provider Demographics
NPI:1659049781
Name:COOK, SAMANTHA (MSW, LSCW)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:MSW, LSCW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3517 S 500 E
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46953-9582
Mailing Address - Country:US
Mailing Address - Phone:765-618-6372
Mailing Address - Fax:
Practice Address - Street 1:1000 N BROADWAY
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-1070
Practice Address - Country:US
Practice Address - Phone:574-722-5151
Practice Address - Fax:574-739-1414
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99106348A104100000X
IN34010806A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker