Individual
THERESA COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17-07 ROMAINE ST, FAIR LAWN, NJ 07410-2150
(201) 937-6679
Mailing address
17-07 ROMAINE ST, FAIR LAWN, NJ 07410-2150
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
29028530
—
NJ
Enumeration date
01/04/2019
Last updated
01/04/2019
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