Provider Demographics
NPI:1952460040
Name:COHEN, DEBRA J
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:J
Last Name:COHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3269 COCOPLUM CIR
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5908
Mailing Address - Country:US
Mailing Address - Phone:954-972-7095
Mailing Address - Fax:
Practice Address - Street 1:7481 W OAKLAND PARK BLVD
Practice Address - Street 2:STE 100
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-4985
Practice Address - Country:US
Practice Address - Phone:888-852-6672
Practice Address - Fax:305-891-4228
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 54071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAD261ROtherMEDICARE PTAN
FL026267900Medicaid
FLAD261YMedicare PIN