MEDICARE: MS. SUSAN K COOK M.A., L.C.S.W.,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	002127	CT
2	101YP2500X	Professional Counselor	SW4204	FL
3	101YP2500X	Professional Counselor	R014042-1	NY

General Provider Information

NPI Number	:	1023036183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN K COOK M.A., L.C.S.W.,

Provider Business Mailing Address
First Line	:	48 DON BOB RD
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06903-3003
Country	:	US
Telephone Number	:	203-968-6180
Fax Number	:

Provider Business Practice Location Address
First Line	:	48 DON BOB RD
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06903-3003
Country	:	US
Telephone Number	:	203-968-6180
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/08/2007

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