Provider Demographics
NPI:1912381104
Name:COOKE, DANIELLE (BCBA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:COOKE
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 1:1441 MAIN ST
Mailing Address - Street 2:SUITE 900
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1406
Mailing Address - Country:US
Mailing Address - Phone:508-808-0323
Mailing Address - Fax:
Practice Address - Street 1:1441 MAIN ST
Practice Address - Street 2:SUITE 900
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1406
Practice Address - Country:US
Practice Address - Phone:508-808-0323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110026265EMedicaid