Provider Demographics
NPI:1679523161
Name:COHEN, KERI S (LCSW)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:S
Last Name:COHEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KERI
Other - Middle Name:S
Other - Last Name:ULLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1340 STILLWATER RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-5328
Mailing Address - Country:US
Mailing Address - Phone:717-951-4939
Mailing Address - Fax:717-945-5074
Practice Address - Street 1:15 S STATE ST STE 105
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17508-5090
Practice Address - Country:US
Practice Address - Phone:717-945-5064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0120581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50032634OtherCAPITAL BLUE CROSS
279820OtherVALUE OPTIONS