Provider Demographics
NPI:1003035957
Name:COHN, SUSAN DEBRA (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DEBRA
Last Name:COHN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:DEBRA
Other - Last Name:HAHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1999 S COAST HWY
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-3663
Mailing Address - Country:US
Mailing Address - Phone:949-494-0544
Mailing Address - Fax:
Practice Address - Street 1:1999 S COAST HWY
Practice Address - Street 2:SUITE 7
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-3663
Practice Address - Country:US
Practice Address - Phone:949-494-0544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS126061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical