Provider Demographics
NPI:1477691202
Name:COOK, MICHELLE ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ELIZABETH
Last Name:COOK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2043 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-9665
Mailing Address - Country:US
Mailing Address - Phone:207-344-6290
Mailing Address - Fax:
Practice Address - Street 1:331 PINE ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6308
Practice Address - Country:US
Practice Address - Phone:207-344-6290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC106351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical