Provider Demographics
NPI:1689941916
Name:KOSMIN, SANDRA H (MSS, LCSW)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:H
Last Name:KOSMIN
Suffix:
Gender:F
Credentials:MSS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 382
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046
Mailing Address - Country:US
Mailing Address - Phone:610-832-0627
Mailing Address - Fax:
Practice Address - Street 1:114 FORREST AVENUE
Practice Address - Street 2:SUITE 2
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19046
Practice Address - Country:US
Practice Address - Phone:610-832-0627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2013-06-05
Deactivation Date:2012-08-24
Deactivation Code:
Reactivation Date:2013-06-05
Provider Licenses
StateLicense IDTaxonomies
PACW-015418104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker