Provider Demographics
NPI:1336399617
Name:PETROW-COHEN, MADELYN (LCSW)
Entity Type:Individual
Prefix:
First Name:MADELYN
Middle Name:
Last Name:PETROW-COHEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SHERIDAN SQ FRNT A
Mailing Address - Street 2:#5
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-6847
Mailing Address - Country:US
Mailing Address - Phone:212-627-8538
Mailing Address - Fax:212-627-8535
Practice Address - Street 1:15 SHERIDAN SQ FRNT A
Practice Address - Street 2:#5
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-6847
Practice Address - Country:US
Practice Address - Phone:212-627-8538
Practice Address - Fax:212-627-8535
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047168-11041C0700X
NJ44SC053468001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7268699OtherAETNA
NY7268699OtherAETNA
NYN0T421Medicare UPIN