Provider Demographics
NPI:1689681009
Name:COHAN, AMY D (LICSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:D
Last Name:COHAN
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 1:23 BUTTONWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-1705
Mailing Address - Country:US
Mailing Address - Phone:781-834-7900
Mailing Address - Fax:781-837-8312
Practice Address - Street 1:65 FOREST ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-2845
Practice Address - Country:US
Practice Address - Phone:781-834-7900
Practice Address - Fax:781-837-8312
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1115911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP08419OtherBLUECROSS/BLUESHIELD MA
MA2162820OtherCIGNA
MA2027587OtherHCVM CCN FIRST HEALTH
MAP08419OtherBLUECROSS/BLUESHIELD MA