Healthcare Provider Details

I. General information

NPI: 1295930675
Provider Name (Legal Business Name): BRIAN COHEN LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 01/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 MAIN ST STE. 4A
HUDSON MA
01749-2164
US

IV. Provider business mailing address

21 MAIN ST STE. 4A
HUDSON MA
01749-2164
US

V. Phone/Fax

Practice location:
  • Phone: 978-212-5769
  • Fax:
Mailing address:
  • Phone: 978-212-5769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number110821
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier110821
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerMASSACHUSETTS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: