MEDICARE: DR. ROOSEVELT COHENS LPC

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	101YM0800X	Mental Health Counselor	PRC985	DC
2	1041C0700X	Clinical Social Worker	LC50080419	DC

General Provider Information

NPI Number	:	1568801587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROOSEVELT COHENS LPC

Provider Business Mailing Address
First Line	:	3909 SNOW FAWN AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-4960
Country	:	US
Telephone Number	:	202-373-2853
Fax Number	:	202-506-3712

Provider Business Practice Location Address
First Line	:	3909 SNOW FAWN AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-4960
Country	:	US
Telephone Number	:	202-373-2853
Fax Number	:	202-506-3711

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

Provider Enumeration Date	:	06/24/2013
Last Update Date	:	01/30/2023

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