Healthcare Provider Details

I. General information

NPI: 1477691202
Provider Name (Legal Business Name): MICHELLE ELIZABETH COOK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 08/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 PINE ST
LEWISTON ME
04240-6308
US

IV. Provider business mailing address

2043 RIVERSIDE DR
AUBURN ME
04210-9665
US

V. Phone/Fax

Practice location:
  • Phone: 207-344-6290
  • Fax:
Mailing address:
  • Phone: 207-344-6290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMC10635
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: