Healthcare Provider Details

I. General information

NPI: 1831271691
Provider Name (Legal Business Name): REBECCA M COHEN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 BERKSHIRE RD SUITE B
SANDY HOOK CT
06482-1361
US

IV. Provider business mailing address

15 BERKSHIRE RD SUITE B
SANDY HOOK CT
06482-1361
US

V. Phone/Fax

Practice location:
  • Phone: 203-733-6018
  • Fax:
Mailing address:
  • Phone: 203-733-6018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number005269
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: