Provider Demographics
NPI:1871024067
Name:COHEN, JEANETTE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 BISHOP RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-2511
Mailing Address - Country:US
Mailing Address - Phone:202-378-3657
Mailing Address - Fax:
Practice Address - Street 1:79 WEST ST
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2426
Practice Address - Country:US
Practice Address - Phone:443-837-5724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC195131041C0700X
DCLC500788621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical