MEDICARE: JOHANNA COHEN 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	44SC05377500	NJ

General Provider Information

NPI Number	:	1710116553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHANNA COHEN L.C.S.W.

Provider Business Mailing Address
First Line	:	866 SALEM AVE
Second Line	:
City	:	HILLSIDE
State	:	NJ
Zip	:	07205-3035
Country	:	US
Telephone Number	:	908-943-7641
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 W JERSEY ST STE 104
Second Line	:
City	:	ELIZABETH
State	:	NJ
Zip	:	07202-1352
Country	:	US
Telephone Number	:	908-469-9440
Fax Number	:

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

Provider Enumeration Date	:	07/14/2009
Last Update Date	:	06/21/2019

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