Provider Demographics
NPI:1639865942
Name:COSBY, CONSTANCE (LCSW)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:COSBY
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 1:2722 N HANCOCK ST UNIT 304
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19133-3539
Mailing Address - Country:US
Mailing Address - Phone:215-469-1668
Mailing Address - Fax:
Practice Address - Street 1:2722 N HANCOCK ST UNIT 304
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133-3539
Practice Address - Country:US
Practice Address - Phone:215-469-1668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-11
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0235381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical