Provider Demographics
NPI:1619225000
Name:COGAN, MITCHELL (LMFT)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:COGAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1637 POPLAR ST APT 6F
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-1755
Mailing Address - Country:US
Mailing Address - Phone:856-425-2942
Mailing Address - Fax:
Practice Address - Street 1:1637 POPLAR ST APT 6F
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-1755
Practice Address - Country:US
Practice Address - Phone:856-425-2942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
NJ3TP12-009106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist