Provider Demographics
NPI:1023186608
Name:COHEN, MIRIAM GALPER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:GALPER
Last Name:COHEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 CHELFIELD RD
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-1401
Mailing Address - Country:US
Mailing Address - Phone:215-884-8235
Mailing Address - Fax:215-884-4915
Practice Address - Street 1:MEDICAL TOWER SUITE 1509
Practice Address - Street 2:255 SOUTH 17TH STREET
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6231
Practice Address - Country:US
Practice Address - Phone:215-884-8235
Practice Address - Fax:215-884-4915
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW-000704-L101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA708765OtherBLUE SHIELD