MEDICARE: MR. KEVIN KEITH SUTTON COOK LPC

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	1041C0700X	Clinical Social Worker	37PC00430800	NJ

General Provider Information

NPI Number	:	1518226695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEVIN KEITH SUTTON COOK LPC

Provider Business Mailing Address
First Line	:	PO BOX 2531
Second Line	:
City	:	WILDWOOD
State	:	NJ
Zip	:	08260-8531
Country	:	US
Telephone Number	:	814-504-4923
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 CREST HAVEN RD
Second Line	:
City	:	CAPE MAY COURT HOUSE
State	:	NJ
Zip	:	08210-1652
Country	:	US
Telephone Number	:	609-465-4100
Fax Number	:	609-465-2588

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

Provider Enumeration Date	:	05/10/2012
Last Update Date	:	05/10/2012

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