Provider Demographics
NPI:1114110673
Name:COHEN, DAVID (LCSW, CADC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:COHEN
Suffix:
Gender:M
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 N LAKE SHORE DR
Mailing Address - Street 2:17BN
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-2371
Mailing Address - Country:US
Mailing Address - Phone:312-882-1212
Mailing Address - Fax:
Practice Address - Street 1:2644 30TH ST STE 100
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3051
Practice Address - Country:US
Practice Address - Phone:310-314-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-19
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA764071041C0700X
IL21246461041S0200X
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool