Provider Demographics
NPI:1245540293
Name:COOK, ROSEMARY (PHD)
Entity type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 TIPPIN DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-2130
Mailing Address - Country:US
Mailing Address - Phone:631-935-2967
Mailing Address - Fax:631-427-5807
Practice Address - Street 1:2704 GRAND AVE STE 5
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-3599
Practice Address - Country:US
Practice Address - Phone:631-935-2967
Practice Address - Fax:516-307-3396
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103T00000X
NY823161103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool