Healthcare Provider Details

I. General information

NPI: 1053555771
Provider Name (Legal Business Name): MADELINE BURGEN COHEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 N, SABINO CANYON RD.
TUCSON AZ
85750-6435
US

IV. Provider business mailing address

7775 E. WINDRIVER DR.
TUCSON AZ
85750-7017
US

V. Phone/Fax

Practice location:
  • Phone: 520-243-9287
  • Fax:
Mailing address:
  • Phone: 520-243-9287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-1919
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: