Healthcare Provider Details

I. General information

NPI: 1053455485
Provider Name (Legal Business Name): LYNN J COHEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2338 HUNTINGDON PIKE
HUNTINGDON VALLEY PA
19006-6110
US

IV. Provider business mailing address

750 BRISTOL RD
SOUTHAMPTON PA
18966-3922
US

V. Phone/Fax

Practice location:
  • Phone: 215-947-2784
  • Fax:
Mailing address:
  • Phone: 215-355-8037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW-002586-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: