Provider Demographics
NPI:1679957518
Name:COHEN, DANA BETH (LCSW)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:BETH
Last Name:COHEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 HOLLISTER DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5263
Mailing Address - Country:US
Mailing Address - Phone:847-549-1189
Mailing Address - Fax:847-932-4066
Practice Address - Street 1:1800 HOLLISTER DR
Practice Address - Street 2:SUITE 201
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5263
Practice Address - Country:US
Practice Address - Phone:847-549-1189
Practice Address - Fax:847-932-4066
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0176601041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical