Healthcare Provider Details

I. General information

NPI: 1275100307
Provider Name (Legal Business Name): LEONIE COHEN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 ELM ST STE 201
SOMERVILLE MA
02144-2947
US

IV. Provider business mailing address

255 ELM ST STE 201
SOMERVILLE MA
02144-2947
US

V. Phone/Fax

Practice location:
  • Phone: 617-702-9131
  • Fax: 617-812-2412
Mailing address:
  • Phone: 617-702-9131
  • Fax: 617-812-2412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1120298
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: