Provider Demographics
NPI:1164875613
Name:KAVADLO-COHEN, JOAN (MSPED)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:KAVADLO-COHEN
Suffix:
Gender:F
Credentials:MSPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22307 59TH AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1932
Mailing Address - Country:US
Mailing Address - Phone:917-915-5553
Mailing Address - Fax:
Practice Address - Street 1:22307 59TH AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-1932
Practice Address - Country:US
Practice Address - Phone:917-915-5553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health