Provider Demographics
NPI:1457783920
Name:COOK, CARRIE LEE (BCBA)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LEE
Last Name:COOK
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:LEE
Other - Last Name:CAPANYOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2275 ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-1132
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2695 S JERSEY ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6321
Practice Address - Country:US
Practice Address - Phone:303-759-1192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CO1-18-30298103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor