Provider Demographics
NPI:1184787087
Name:KOSEN, SHEILA BETH (LCSW, CAP)
Entity type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:BETH
Last Name:KOSEN
Suffix:
Gender:F
Credentials:LCSW, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 NE 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-4132
Mailing Address - Country:US
Mailing Address - Phone:954-788-3293
Mailing Address - Fax:
Practice Address - Street 1:7301 N UNIVERSITY DR STE 210
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2935
Practice Address - Country:US
Practice Address - Phone:954-720-4350
Practice Address - Fax:954-720-1009
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2937101YA0400X
FL61791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical