Healthcare Provider Details

I. General information

NPI: 1104739655
Provider Name (Legal Business Name): AMIR KOHEN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S BROAD ST STE 1114
PHILADELPHIA PA
19110-1003
US

IV. Provider business mailing address

210 S 13TH ST APT 3
PHILADELPHIA PA
19107-5491
US

V. Phone/Fax

Practice location:
  • Phone: 267-852-6089
  • Fax:
Mailing address:
  • Phone: 267-852-6089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW028025
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: