Provider Demographics
NPI:1174878284
Name:COOK, MELANIE ANN
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANN
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 BELLA VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-2304
Mailing Address - Country:US
Mailing Address - Phone:415-290-8545
Mailing Address - Fax:
Practice Address - Street 1:1904 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2912
Practice Address - Country:US
Practice Address - Phone:510-428-2028
Practice Address - Fax:510-428-2025
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist