Provider Demographics
NPI:1710188297
Name:COCHRAN, SUSAN KAY (LCSW, CSW-G, ACSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAY
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:LCSW, CSW-G, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2831 MOUNT TABOR RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-2075
Mailing Address - Country:US
Mailing Address - Phone:812-949-2253
Mailing Address - Fax:812-949-1335
Practice Address - Street 1:2580 CHARLESTOWN RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2555
Practice Address - Country:US
Practice Address - Phone:502-817-3379
Practice Address - Fax:812-949-1335
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001501A1041C0700X
KY9321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYS38322Medicare UPIN
KY0767701Medicare ID - Type UnspecifiedLCSW
IN201660AMedicare ID - Type UnspecifiedCSW