Healthcare Provider Details

I. General information

NPI: 1134686033
Provider Name (Legal Business Name): MELISSA SACHS-KOHEN LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 N CHARLES ST
TOWSON MD
21204-3780
US

IV. Provider business mailing address

5001 BROADMOOR RD
BALTIMORE MD
21212-3810
US

V. Phone/Fax

Practice location:
  • Phone: 443-809-0133
  • Fax:
Mailing address:
  • Phone: 410-409-5045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number18506
License Number StateMD

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: