Provider Demographics
NPI:1710132329
Name:COBB, KEVIN R (CASAC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:R
Last Name:COBB
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 JOHN ST
Mailing Address - Street 2:27 FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-3300
Mailing Address - Country:US
Mailing Address - Phone:212-385-0086
Mailing Address - Fax:212-732-0757
Practice Address - Street 1:116 JOHN ST
Practice Address - Street 2:27 FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-3300
Practice Address - Country:US
Practice Address - Phone:212-385-0086
Practice Address - Fax:212-732-0757
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19853101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY133480517OtherWORKS FOR CIS COUNSELING CENTER, INC.