Provider Demographics
NPI:1093497653
Name:COSMO, SERENA (MA)
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:COSMO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2328 HABERSHAM DR SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-3806
Mailing Address - Country:US
Mailing Address - Phone:404-405-0922
Mailing Address - Fax:
Practice Address - Street 1:4255 WADE GREEN RD NW STE 414
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1763
Practice Address - Country:US
Practice Address - Phone:770-603-0123
Practice Address - Fax:678-922-7767
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor