Provider Demographics
NPI:1578813572
Name:COHEN, BRADLEY R (LCSW, CAP, ICADC)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:R
Last Name:COHEN
Suffix:
Gender:M
Credentials:LCSW, CAP, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 SOUTH UNIVERSITY DRIVE, #119
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328
Mailing Address - Country:US
Mailing Address - Phone:954-258-0739
Mailing Address - Fax:
Practice Address - Street 1:5400 SOUTH UNIVERSITY DRIVE, #119
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328
Practice Address - Country:US
Practice Address - Phone:954-258-0739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP5125101YA0400X
FLICADC126606101YA0400X
FLSW109501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)