Provider Demographics
NPI:1922828334
Name:MESFIN-COOK, LA'SANDRA (LMFT)
Entity type:Individual
Prefix:
First Name:LA'SANDRA
Middle Name:
Last Name:MESFIN-COOK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1939 FAIRMOUNT AVE UNIT 56055
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2041
Mailing Address - Country:US
Mailing Address - Phone:267-241-2496
Mailing Address - Fax:
Practice Address - Street 1:1939 FAIRMOUNT AVE UNIT 56055
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-2041
Practice Address - Country:US
Practice Address - Phone:267-241-2496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF001619106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist