Healthcare Provider Details

I. General information

NPI: 1679523161
Provider Name (Legal Business Name): KERI S COHEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KERI S ULLMAN

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 12/31/2020
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 S STATE ST STE 105
BROWNSTOWN PA
17508-5090
US

IV. Provider business mailing address

1340 STILLWATER RD
LANCASTER PA
17601-5328
US

V. Phone/Fax

Practice location:
  • Phone: 717-945-5064
  • Fax:
Mailing address:
  • Phone: 717-951-4939
  • Fax: 717-945-5074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW012058
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: