Healthcare Provider Details

I. General information

NPI: 1134376783
Provider Name (Legal Business Name): CASEY L COOK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 POLK STREET SUITE 300
WATERTOWN NY
13601-2770
US

IV. Provider business mailing address

PO BOX 6550 167 POLK STREET, SUITE 300
WATERTOWN NY
13601-6550
US

V. Phone/Fax

Practice location:
  • Phone: 315-782-7445
  • Fax: 315-779-1184
Mailing address:
  • Phone: 315-782-7445
  • Fax: 315-779-1184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number095113
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: