Provider Demographics
NPI:1548354269
Name:COHEN, SHERRY M (MED, MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:M
Last Name:COHEN
Suffix:
Gender:F
Credentials:MED, MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 MOSSMAN STREET
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-1303
Mailing Address - Country:US
Mailing Address - Phone:617-332-3054
Mailing Address - Fax:617-964-4432
Practice Address - Street 1:59 MOSSMAN STREET
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02465-1303
Practice Address - Country:US
Practice Address - Phone:617-332-3054
Practice Address - Fax:617-964-4432
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10187701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO5298Medicare ID - Type Unspecified