Provider Demographics
NPI:1538210372
Name:COHEN, SUSAN ELLEN (LICSW,LMFT,ACSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ELLEN
Last Name:COHEN
Suffix:
Gender:F
Credentials:LICSW,LMFT,ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LAKE BELLEVUE DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2417
Mailing Address - Country:US
Mailing Address - Phone:425-454-0534
Mailing Address - Fax:425-635-0883
Practice Address - Street 1:1 LAKE BELLEVUE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2417
Practice Address - Country:US
Practice Address - Phone:425-454-0534
Practice Address - Fax:425-635-0883
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000053521041C0700X
WALF00001060106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist