Provider Demographics
NPI:1447021837
Name:KIM COOKE COUNSELING LLC
Entity type:Organization
Organization Name:KIM COOKE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-861-3070
Mailing Address - Street 1:353 CORNELL ST
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-2832
Mailing Address - Country:US
Mailing Address - Phone:617-861-3070
Mailing Address - Fax:
Practice Address - Street 1:353 CORNELL ST
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-2832
Practice Address - Country:US
Practice Address - Phone:617-861-3070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health