Provider Demographics
NPI:1033720958
Name:COHEN, FERN (LMSW)
Entity Type:Individual
Prefix:
First Name:FERN
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:FERN
Other - Middle Name:
Other - Last Name:WEINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6416 MISTY TOP PASS
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-6000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6416 MISTY TOP PASS
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-6000
Practice Address - Country:US
Practice Address - Phone:443-794-1763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG04705104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG04705OtherLICENSE