Healthcare Provider Details

I. General information

NPI: 1194457549
Provider Name (Legal Business Name): WENDY COOK PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2022
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 PLAZA REAL STE 275
BOCA RATON FL
33432-3999
US

IV. Provider business mailing address

433 PLAZA REAL STE 275
BOCA RATON FL
33432-3999
US

V. Phone/Fax

Practice location:
  • Phone: 561-299-0230
  • Fax:
Mailing address:
  • Phone: 561-299-0230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4627
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: