Provider Demographics
NPI:1568214211
Name:COOK, GABRIELLE (BCBA)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 CHARON TER
Mailing Address - Street 2:
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-2102
Mailing Address - Country:US
Mailing Address - Phone:617-999-0302
Mailing Address - Fax:
Practice Address - Street 1:164 RACE ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-5874
Practice Address - Country:US
Practice Address - Phone:413-537-3194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-24-72099103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst