Provider Demographics
NPI:1891278586
Name:COOK, DONALD GEORGE
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:GEORGE
Last Name:COOK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 302
Mailing Address - Street 2:
Mailing Address - City:MILL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:01244-0302
Mailing Address - Country:US
Mailing Address - Phone:413-229-3243
Mailing Address - Fax:
Practice Address - Street 1:777 MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-2120
Practice Address - Country:US
Practice Address - Phone:413-528-4014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1121631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical