Provider Demographics
NPI:1508384413
Name:COOK, ELIZABETH SIMONE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:SIMONE
Last Name:COOK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 WATER FOUNTAIN WAY UNIT 303
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-2312
Mailing Address - Country:US
Mailing Address - Phone:410-800-7966
Mailing Address - Fax:
Practice Address - Street 1:JOHNS HOPKINS UNIVERSITY
Practice Address - Street 2:933 N WOLFE ST
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205
Practice Address - Country:US
Practice Address - Phone:410-955-3250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06573103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD06573OtherMARYLAND BOARD OF EXAMINERS OF PSYCHOLOGISTS