Healthcare Provider Details

I. General information

NPI: 1548753528
Provider Name (Legal Business Name): NORMAN V COSBY LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 07/12/2025
Certification Date: 07/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W MONUMENT AVE APT 1201
DAYTON OH
45402-3098
US

IV. Provider business mailing address

115 W MONUMENT AVE APT 1201
DAYTON OH
45402-3098
US

V. Phone/Fax

Practice location:
  • Phone: 859-537-7254
  • Fax:
Mailing address:
  • Phone: 859-537-7254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1904510
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: