=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063558799
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BETSY COHEN L.C.S.W.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 905 SANTA FE AVE
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94706-2119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-527-1131
-----------------------------------------------------
Fax | 510-843-6703
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1175 MILLER AVE
-----------------------------------------------------
City | BERKELEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94708-1754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-527-1131
-----------------------------------------------------
Fax | 510-843-6703
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | C4075
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------