Healthcare Provider Details

I. General information

NPI: 1205230240
Provider Name (Legal Business Name): ALICIA COHEN LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 SANDBURG TER
OLNEY MD
20832-2531
US

IV. Provider business mailing address

3301 SANDBURG TER
OLNEY MD
20832-2531
US

V. Phone/Fax

Practice location:
  • Phone: 240-200-0937
  • Fax:
Mailing address:
  • Phone: 240-200-0937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC200003030
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17959
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904016107
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: