Provider Demographics
NPI:1245481324
Name:COOK, SUSAN ANNE (PSYD)
Entity type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:ANNE
Last Name:COOK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2143 MORRIS AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6036
Mailing Address - Country:US
Mailing Address - Phone:908-686-4145
Mailing Address - Fax:908-851-2128
Practice Address - Street 1:2143 MORRIS AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6036
Practice Address - Country:US
Practice Address - Phone:908-686-4145
Practice Address - Fax:908-851-2128
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100253200103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical