Provider Demographics
NPI:1760788129
Name:COOK, SHANEY Q (MA, LCMHC)
Entity Type:Individual
Prefix:
First Name:SHANEY
Middle Name:Q
Last Name:COOK
Suffix:
Gender:F
Credentials:MA, LCMHC
Other - Prefix:
Other - First Name:SHANEY
Other - Middle Name:
Other - Last Name:CURRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LCMHC
Mailing Address - Street 1:2 WASHINGTON ST STE 312
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-3890
Mailing Address - Country:US
Mailing Address - Phone:603-787-3104
Mailing Address - Fax:
Practice Address - Street 1:2 WASHINGTON ST STE 312
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3890
Practice Address - Country:US
Practice Address - Phone:603-787-3104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC4954101YA0400X, 101YM0800X
FLMH10321101YA0400X, 101YM0800X
NH1114101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3102222Medicaid