Healthcare Provider Details

I. General information

NPI: 1679729974
Provider Name (Legal Business Name): ANDREA GAYLE COOK PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 07/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 MIRAMONTES ST STE 100D
HALF MOON BAY CA
94019-1942
US

IV. Provider business mailing address

PO BOX 913
PESCADERO CA
94060-0913
US

V. Phone/Fax

Practice location:
  • Phone: 650-489-2299
  • Fax:
Mailing address:
  • Phone: 650-489-2299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: