Provider Demographics
NPI:1023007572
Name:COHN, SUSAN (MSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:COHN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21710 STEVENS CREEK BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-1172
Mailing Address - Country:US
Mailing Address - Phone:408-257-5772
Mailing Address - Fax:888-875-1557
Practice Address - Street 1:21710 STEVENS CREEK BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-1172
Practice Address - Country:US
Practice Address - Phone:408-257-5772
Practice Address - Fax:888-875-1557
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 53761041C0700X
CAMFT 8177106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ17803ZMedicare PIN