MEDICARE: MR. ROBERT COHEN LICSW

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	102821	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	102821	OTHER	MA	TUFTS HEALTH PLAN ID
2	102821	OTHER	MA	STATE LICENSE NUMBER
3	008444	OTHER	MA	VALUEOPTIONS ID
4	P01181	OTHER	MA	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1811076177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT COHEN LICSW

Provider Business Mailing Address
First Line	:	7 CENTRAL ST
Second Line	:	SUITE 222
City	:	ARLINGTON
State	:	MA
Zip	:	02476-4800
Country	:	US
Telephone Number	:	781-641-4100
Fax Number	:	781-641-4101

Provider Business Practice Location Address
First Line	:	7 CENTRAL ST
Second Line	:	SUITE 222
City	:	ARLINGTON
State	:	MA
Zip	:	02476-4800
Country	:	US
Telephone Number	:	781-641-4100
Fax Number	:	781-641-4101

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/08/2007

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