MEDICARE: MITCHELL COGAN LMFT

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	106H00000X	Marriage & Family Therapist
2	106H00000X	Marriage & Family Therapist	3TP12-009	NJ

General Provider Information

NPI Number	:	1619225000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL COGAN LMFT

Provider Business Mailing Address
First Line	:	1637 POPLAR ST APT 6F
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-1755
Country	:	US
Telephone Number	:	856-425-2942
Fax Number	:

Provider Business Practice Location Address
First Line	:	1637 POPLAR ST APT 6F
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-1755
Country	:	US
Telephone Number	:	856-425-2942
Fax Number	:

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

Provider Enumeration Date	:	08/16/2012
Last Update Date	:	11/04/2024

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Directions to “ MITCHELL COGAN LMFT” Practice Location

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