Provider Demographics
NPI:1588804769
Name:COGLE, MONICA R (LICSW)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:R
Last Name:COGLE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 FOAL LN
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25405-2562
Mailing Address - Country:US
Mailing Address - Phone:304-919-0001
Mailing Address - Fax:888-596-2658
Practice Address - Street 1:1664 WINCHESTER AVE
Practice Address - Street 2:STE B
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25405-3881
Practice Address - Country:US
Practice Address - Phone:304-901-4347
Practice Address - Fax:888-596-2658
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-27
Last Update Date:2015-06-24
Deactivation Date:2015-06-08
Deactivation Code:
Reactivation Date:2015-06-24
Provider Licenses
StateLicense IDTaxonomies
WVDP009398961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical