MEDICARE: SUSAN DEBRA COHN L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCS12606	CA

General Provider Information

NPI Number	:	1003035957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN DEBRA COHN L.C.S.W.

Provider Business Mailing Address
First Line	:	1999 S COAST HWY
Second Line	:	SUITE 7
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-3663
Country	:	US
Telephone Number	:	949-494-0544
Fax Number	:

Provider Business Practice Location Address
First Line	:	1999 S COAST HWY
Second Line	:	SUITE 7
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-3663
Country	:	US
Telephone Number	:	949-494-0544
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/08/2007

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