Provider Demographics
NPI:1013638931
Name:COHEN, SAMANTHA A (LMSW)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:A
Last Name:COHEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 STATE ST APT 502
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2776
Mailing Address - Country:US
Mailing Address - Phone:203-464-0176
Mailing Address - Fax:
Practice Address - Street 1:30 HOLMES AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06710-2412
Practice Address - Country:US
Practice Address - Phone:203-755-2868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6555104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker