Healthcare Provider Details

I. General information

NPI: 1033586391
Provider Name (Legal Business Name): GINA MARIE COHEN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REGINA NOLAN

II. Dates (important events)

Enumeration Date: 08/21/2015
Last Update Date: 08/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 MARTIN LUTHER KING JR WAY S
SEATTLE WA
98144-4801
US

IV. Provider business mailing address

1116 SUMMIT AVE
SEATTLE WA
98101-2831
US

V. Phone/Fax

Practice location:
  • Phone: 206-322-7676
  • Fax:
Mailing address:
  • Phone: 206-323-0930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number00009498
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: