Provider Demographics
NPI:1558450387
Name:BROWN-COOKE, WINSOME S (MSW)
Entity Type:Individual
Prefix:MRS
First Name:WINSOME
Middle Name:S
Last Name:BROWN-COOKE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 BROADWAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2327
Mailing Address - Country:US
Mailing Address - Phone:516-797-4851
Mailing Address - Fax:631-264-3085
Practice Address - Street 1:707 BROADWAY
Practice Address - Street 2:SUITE 2
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2327
Practice Address - Country:US
Practice Address - Phone:516-797-4851
Practice Address - Fax:631-264-3085
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040445-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN474Y2Medicare ID - Type Unspecified