Provider Demographics
NPI:1750872495
Name:COOKMAN, CRYSTAL (PSYD)
Entity type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:
Last Name:COOKMAN
Suffix:
Gender:
Credentials:PSYD
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 400
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-0007
Mailing Address - Country:US
Mailing Address - Phone:978-272-0633
Mailing Address - Fax:
Practice Address - Street 1:814 ELM ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-2130
Practice Address - Country:US
Practice Address - Phone:603-860-0623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-29
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10852103TC0700X
MA10756103TC0700X
NH1505103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical