Provider Demographics
NPI:1013120229
Name:COHEN, CRAIG MITCHELL (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:MITCHELL
Last Name:COHEN
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 N WOODSTOCK ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1111
Mailing Address - Country:US
Mailing Address - Phone:215-779-5803
Mailing Address - Fax:
Practice Address - Street 1:1601 WALNUT ST STE 406
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-2903
Practice Address - Country:US
Practice Address - Phone:215-779-5803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0151121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical