Provider Demographics
NPI:1528151545
Name:COHEN, PAUL (LCSW)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:COHEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63-84 SAUNDERS ST.
Mailing Address - Street 2:APT 1C
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374
Mailing Address - Country:US
Mailing Address - Phone:917-576-9388
Mailing Address - Fax:
Practice Address - Street 1:8437 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-1643
Practice Address - Country:US
Practice Address - Phone:917-576-9388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0687191104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
7352839OtherGHI
P3639486OtherOXFORD
0256FMMedicare ID - Type Unspecified