Provider Demographics
NPI:1942418876
Name:COHEN, ROBIN SUSAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:SUSAN
Last Name:COHEN
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 1:11686 GILMAN LN
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-2419
Mailing Address - Country:US
Mailing Address - Phone:703-444-4610
Mailing Address - Fax:
Practice Address - Street 1:12040 S LAKES DR
Practice Address - Street 2:SUITE 204
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-1246
Practice Address - Country:US
Practice Address - Phone:703-625-4836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040027401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904002740OtherVA LICENSE ID NO