Provider Demographics
NPI:1174847206
Name:COOK, TRUDY MARY (LCSW, PC)
Entity Type:Individual
Prefix:MRS
First Name:TRUDY
Middle Name:MARY
Last Name:COOK
Suffix:
Gender:F
Credentials:LCSW, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2116
Mailing Address - Street 2:
Mailing Address - City:SURF CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28445-0018
Mailing Address - Country:US
Mailing Address - Phone:631-478-2649
Mailing Address - Fax:910-541-0711
Practice Address - Street 1:307 VESTA CT
Practice Address - Street 2:
Practice Address - City:SURF CITY
Practice Address - State:NC
Practice Address - Zip Code:28445-6684
Practice Address - Country:US
Practice Address - Phone:631-478-2649
Practice Address - Fax:910-541-0711
Is Sole Proprietor?:No
Enumeration Date:2010-03-18
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0145191041C0700X
NY079968104100000X
NY0842641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker