Provider Demographics
NPI:1891824124
Name:COHEN, LARRY IRA (LICSW)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:IRA
Last Name:COHEN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4808 43RD PL NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4502
Mailing Address - Country:US
Mailing Address - Phone:202-244-0903
Mailing Address - Fax:202-244-4517
Practice Address - Street 1:4808 43RD PL NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4502
Practice Address - Country:US
Practice Address - Phone:202-244-0903
Practice Address - Fax:202-244-4517
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC003022361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC656091Medicare ID - Type Unspecified