Provider Demographics
NPI:1770581407
Name:COOKE, LINDA JEAN (MSW, LCSW, BCD)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:JEAN
Last Name:COOKE
Suffix:
Gender:F
Credentials:MSW, LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-7005
Mailing Address - Country:US
Mailing Address - Phone:207-467-9092
Mailing Address - Fax:888-467-9205
Practice Address - Street 1:11 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-7005
Practice Address - Country:US
Practice Address - Phone:207-467-9092
Practice Address - Fax:888-467-9205
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC94071041C0700X
MA10229211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME0750Medicare PIN