Provider Demographics
NPI:1114002193
Name:COHEN, ALISE R (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ALISE
Middle Name:R
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 1:120 NORTH MAIN STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956
Mailing Address - Country:US
Mailing Address - Phone:845-638-9359
Mailing Address - Fax:845-638-6770
Practice Address - Street 1:120 NORTH MAIN STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956
Practice Address - Country:US
Practice Address - Phone:845-638-9359
Practice Address - Fax:845-638-6770
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0315181104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker