Provider Demographics
NPI:1992865265
Name:COBURN, LETITIA V (LCSW, CASAC)
Entity Type:Individual
Prefix:MS
First Name:LETITIA
Middle Name:V
Last Name:COBURN
Suffix:
Gender:F
Credentials:LCSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1872 PLEASANTVILLE RD # 129
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510-1051
Mailing Address - Country:US
Mailing Address - Phone:914-471-2632
Mailing Address - Fax:914-944-0595
Practice Address - Street 1:522 N STATE RD STE 202
Practice Address - Street 2:
Practice Address - City:BRIARCLIFF MANOR
Practice Address - State:NY
Practice Address - Zip Code:10510-1536
Practice Address - Country:US
Practice Address - Phone:914-471-2632
Practice Address - Fax:914-944-0595
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0522501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical