Provider Demographics
NPI:1396984472
Name:COHEN, SANDRA B (DSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:B
Last Name:COHEN
Suffix:
Gender:F
Credentials:DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E ROUMFORT RD
Mailing Address - Street 2:UNIT 11
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-1636
Mailing Address - Country:US
Mailing Address - Phone:215-248-2322
Mailing Address - Fax:215-248-4322
Practice Address - Street 1:115 E ROUMFORT RD
Practice Address - Street 2:UNIT 11
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-1636
Practice Address - Country:US
Practice Address - Phone:215-248-2322
Practice Address - Fax:215-248-4322
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW002501L106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist