Healthcare Provider Details

I. General information

NPI: 1164761920
Provider Name (Legal Business Name): DANA JEAN COOK LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2013
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N MAIN ST
PROVIDENCE RI
02904-5762
US

IV. Provider business mailing address

245 MAIN ST
WOONSOCKET RI
02895-3123
US

V. Phone/Fax

Practice location:
  • Phone: 401-228-7328
  • Fax:
Mailing address:
  • Phone: 401-766-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW02984
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: