Provider Demographics
NPI:1952075046
Name:COHEN, CARLY MICHELLE (LAMFT)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:MICHELLE
Last Name:COHEN
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 9 ACRE CT
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2565
Mailing Address - Country:US
Mailing Address - Phone:856-495-8444
Mailing Address - Fax:
Practice Address - Street 1:805 COOPER RD STE 3
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3814
Practice Address - Country:US
Practice Address - Phone:856-495-8444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FA00005200106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist