Healthcare Provider Details

I. General information

NPI: 1679089379
Provider Name (Legal Business Name): SHAKIR COOK MA,LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2017
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 VARICK ST FL 5
NEW YORK NY
10013-1917
US

IV. Provider business mailing address

75 VARICK ST FL 5
NEW YORK NY
10013-1917
US

V. Phone/Fax

Practice location:
  • Phone: 855-961-1942
  • Fax:
Mailing address:
  • Phone: 855-961-1942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC009976
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: