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NPI Code Detail

MEDICARE: SUSAN KAY COCHRAN LCSW, CSW-G, ACSW

MEDICARE: SUSAN KAY COCHRAN LCSW, CSW-G, ACSW
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
11041C0700XClinical Social Worker34001501AIN
21041C0700XClinical Social Worker932KY

General Provider Information

NPI Number : 1710188297
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN KAY COCHRAN LCSW, CSW-G, ACSW
Provider Business Mailing Address
First Line : 2831 MOUNT TABOR RD
Second Line :
City : NEW ALBANY
State : IN
Zip : 47150-2075
Country : US
Telephone Number : 812-949-2253
Fax Number : 812-949-1335
Provider Business Practice Location Address
First Line : 2580 CHARLESTOWN RD
Second Line :
City : NEW ALBANY
State : IN
Zip : 47150-2555
Country : US
Telephone Number : 502-817-3379
Fax Number : 812-949-1335
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2007
Last Update Date : 03/18/2008

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