Basic Information
Provider Information | |||||||||
NPI: | 1871713982 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | COHEN | ||||||||
FirstName: | ELLEN | ||||||||
MiddleName: | SUE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LCSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4487 LUXEMBURG CT | ||||||||
Address2: |   | ||||||||
City: | LAKE WORTH | ||||||||
State: | FL | ||||||||
PostalCode: | 334675093 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5616768208 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 3199 LAKE WORTH RD | ||||||||
Address2: |   | ||||||||
City: | PALM SPRINGS | ||||||||
State: | FL | ||||||||
PostalCode: | 334613652 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5616496500 | ||||||||
FaxNumber: | 9544973857 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/30/2007 | ||||||||
LastUpdateDate: | 04/09/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | SW7935 | FL | Y |   | Behavioral Health & Social Service Providers | Social Worker |   | 101YM0800X | SW7935 | FL | N |   | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | SW7935 | FL | N |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.