Provider Demographics
NPI:1003390998
Name:COOK, ERIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 HALL HILL RD
Mailing Address - Street 2:
Mailing Address - City:LAKE LUZERNE
Mailing Address - State:NY
Mailing Address - Zip Code:12846-3509
Mailing Address - Country:US
Mailing Address - Phone:518-744-1405
Mailing Address - Fax:
Practice Address - Street 1:489 CLIFTON PARK CTR RD
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3815
Practice Address - Country:US
Practice Address - Phone:518-744-1405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022841103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist