Healthcare Provider Details

I. General information

NPI: 1750945945
Provider Name (Legal Business Name): CAITLYN EILEEN COOK LCMHC, LCPC, LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 RIDGE RD
CENTER OSSIPEE NH
03814-6318
US

IV. Provider business mailing address

PO BOX 959
CENTER OSSIPEE NH
03814-0959
US

V. Phone/Fax

Practice location:
  • Phone: 631-848-3396
  • Fax:
Mailing address:
  • Phone: 207-200-8396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC4921
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001765
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2484
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: