Provider Demographics
NPI:1700037819
Name:COGAN, ROBIN L (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:L
Last Name:COGAN
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 1:4696 W OVERLAND RD
Mailing Address - Street 2:SUITE 132
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-2845
Mailing Address - Country:US
Mailing Address - Phone:208-863-7562
Mailing Address - Fax:208-629-4402
Practice Address - Street 1:4696 W OVERLAND RD
Practice Address - Street 2:SUITE 132
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-2845
Practice Address - Country:US
Practice Address - Phone:208-863-7562
Practice Address - Fax:208-629-4402
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-244341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical