Healthcare Provider Details

I. General information

NPI: 1962766105
Provider Name (Legal Business Name): EMILY BETH COHEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 07/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 PRESIDENT ST 1B
BROOKLYN NY
11215-1454
US

IV. Provider business mailing address

820 PRESIDENT ST 1B
BROOKLYN NY
11215-1454
US

V. Phone/Fax

Practice location:
  • Phone: 718-857-5474
  • Fax:
Mailing address:
  • Phone: 718-857-5474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number5907586
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6613744
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: