Provider Demographics
NPI:1760124994
Name:COOK, WESLEY (LCSW)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:
Last Name:COOK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BOYLSTON ST FL 16
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02199-1900
Mailing Address - Country:US
Mailing Address - Phone:888-572-0795
Mailing Address - Fax:978-496-8771
Practice Address - Street 1:800 BOYLSTON ST FL 16
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02199-1900
Practice Address - Country:US
Practice Address - Phone:888-572-0795
Practice Address - Fax:978-496-8771
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MA0002279441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000227944OtherINSURANCE