MEDICARE: MS. CARRIE R. COHEN

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	104100000X	Social Worker	ISW1251	FL

General Provider Information

NPI Number	:	1568748069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARRIE R. COHEN

Provider Business Mailing Address
First Line	:	5212 NE 6TH AVENUE
Second Line	:	4D
City	:	OAKLAND PARK
State	:	FL
Zip	:	33334-3353
Country	:	US
Telephone Number	:	954-587-1008
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 W. BROWARD BLVD
Second Line	:	SUITE 100
City	:	FT. LAUDERDALE
State	:	FL
Zip	:	33312-1018
Country	:	US
Telephone Number	:	954-587-1008
Fax Number	:

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

Provider Enumeration Date	:	10/27/2011
Last Update Date	:	10/27/2011

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