Provider Demographics
NPI:1033642590
Name:TRUDY MARY COOK LCSW PC
Entity Type:Organization
Organization Name:TRUDY MARY COOK LCSW PC
Other - Org Name:TRUDY COOK LCSW, CASAC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW CASAC
Authorized Official - Phone:631-478-2649
Mailing Address - Street 1:1046 TOOKER AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-5048
Mailing Address - Country:US
Mailing Address - Phone:631-478-2649
Mailing Address - Fax:
Practice Address - Street 1:799 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-3812
Practice Address - Country:US
Practice Address - Phone:631-478-2649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-11
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9315235251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health