Provider Demographics
NPI:1174603476
Name:MARKS COOK, KATHERINE M (LCSW LADC)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:M
Last Name:MARKS COOK
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Gender:F
Credentials:LCSW LADC
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Mailing Address - Street 1:30 BOYNTON ST
Mailing Address - Street 2:BOX H EASTPORT HEALTH CARE INC
Mailing Address - City:EASTPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04631
Mailing Address - Country:US
Mailing Address - Phone:207-853-6001
Mailing Address - Fax:207-853-4028
Practice Address - Street 1:30 BOYNTON ST
Practice Address - Street 2:BOX H EASTPORT HEALTH CARE INC
Practice Address - City:EASTPORT
Practice Address - State:ME
Practice Address - Zip Code:04631
Practice Address - Country:US
Practice Address - Phone:207-853-6001
Practice Address - Fax:207-853-4028
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2010-06-02
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Provider Licenses
StateLicense IDTaxonomies
MELC2728101YA0400X
MELC85761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME320310099Medicaid
ME320310099Medicaid