Provider Demographics
NPI:1093214314
Name:COSGROVE, DEIRDRE MARIE (LMFT)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:MARIE
Last Name:COSGROVE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1438 W PORTER ST FL 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-4644
Mailing Address - Country:US
Mailing Address - Phone:609-385-8679
Mailing Address - Fax:
Practice Address - Street 1:100 S BROAD ST STE 1304
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19110-1004
Practice Address - Country:US
Practice Address - Phone:267-838-0066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000976106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist