Basic Information
| Provider Information | |||||||||
| NPI: | 1144830381 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOK | ||||||||
| FirstName: | BRITTANY | ||||||||
| MiddleName: | LINDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 OLD ORCHARD CT | ||||||||
| Address2: | |||||||||
| City: | EAST MORICHES | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119401107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167610775 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1235 MONTAUK HWY | ||||||||
| Address2: | |||||||||
| City: | MASTIC | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119502917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314706788 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2020 | ||||||||
| LastUpdateDate: | 08/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.