Healthcare Provider Details

I. General information

NPI: 1154480598
Provider Name (Legal Business Name): JEFFREY HAMPTON COOK PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSON AVE
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

19151 WARRIOR BROOK DR
GERMANTOWN MD
20874-1470
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-0500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1250
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: