=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811826209
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH STAR PSYCHOLOGICAL SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2026
-----------------------------------------------------
Last Update Date | 05/14/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 HICKORY HOLLOW
-----------------------------------------------------
City | NANTICOKE
-----------------------------------------------------
State | ONTARIO
-----------------------------------------------------
Zip | N0A 1L0
-----------------------------------------------------
Country | CA
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 HICKORY HOLLOW
-----------------------------------------------------
City | NANTICOKE
-----------------------------------------------------
State | ONTARIO
-----------------------------------------------------
Zip | N0A 1L0
-----------------------------------------------------
Country | CA
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST/PRESIDENT
-----------------------------------------------------
Name | DR. BRUCE ROBERT DAVID COOK
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 416-455-6336
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TF0200X
-----------------------------------------------------
Taxonomy Name | Forensic Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------