Provider Demographics
NPI:1326186818
Name:COOK, NANCY ELIZABETH (LICSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ELIZABETH
Last Name:COOK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:94 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:VERGENNES
Mailing Address - State:VT
Mailing Address - Zip Code:05491-1221
Mailing Address - Country:US
Mailing Address - Phone:802-349-6269
Mailing Address - Fax:
Practice Address - Street 1:1 STEELE ST
Practice Address - Street 2:SUITE 113
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-6204
Practice Address - Country:US
Practice Address - Phone:802-862-2383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00010731041C0700X
VA09040052431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011569Medicaid
VT7658395OtherAETNA
VT00068650OtherBCBS OF VERMONT
VT383794OtherMVP
VT2155778OtherCIGNA
VT7658395OtherAETNA
VT1011569Medicaid