Provider Demographics
NPI:1619225000
Name:COGAN, MITCHELL (LMFT)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:COGAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 SPRINGDALE RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2763
Mailing Address - Country:US
Mailing Address - Phone:856-424-1333
Mailing Address - Fax:856-424-7384
Practice Address - Street 1:1301 SPRINGDALE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2763
Practice Address - Country:US
Practice Address - Phone:856-424-1333
Practice Address - Fax:856-424-7384
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3TP12-009106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist