Provider Demographics
NPI:1093805129
Name:COHEN, DEBORAH RUTH (MSW)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:RUTH
Last Name:COHEN
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 1:575 PROFESSIONAL DR STE 510
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-3336
Mailing Address - Country:US
Mailing Address - Phone:770-246-7611
Mailing Address - Fax:770-513-7986
Practice Address - Street 1:575 PROFESSIONAL DR STE 510
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-3336
Practice Address - Country:US
Practice Address - Phone:770-246-7611
Practice Address - Fax:770-513-7986
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical