Healthcare Provider Details

I. General information

NPI: 1164072229
Provider Name (Legal Business Name): NICOLE COHEN LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NIKKI COHEN LSW

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 S 16TH ST
PHILADELPHIA PA
19102-4908
US

IV. Provider business mailing address

313 S 16TH ST
PHILADELPHIA PA
19102-4908
US

V. Phone/Fax

Practice location:
  • Phone: 215-732-8244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: