Provider Demographics
NPI:1023036183
Name:COOK, SUSAN K (MA, LCSW,)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:K
Last Name:COOK
Suffix:
Gender:F
Credentials:MA, LCSW,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 DON BOB RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06903-3003
Mailing Address - Country:US
Mailing Address - Phone:203-968-6180
Mailing Address - Fax:
Practice Address - Street 1:48 DON BOB RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06903-3003
Practice Address - Country:US
Practice Address - Phone:203-968-6180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002127101YP2500X
FLSW4204101YP2500X
NYR014042-1101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional