Provider Demographics
NPI:1811441090
Name:COHEN, ILENE
Entity type:Individual
Prefix:
First Name:ILENE
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ILENE
Other - Middle Name:SUE
Other - Last Name:SHORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1656 SYLVIA DR
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-7145
Mailing Address - Country:US
Mailing Address - Phone:607-761-0885
Mailing Address - Fax:
Practice Address - Street 1:1656 SYLVIA DR
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-7145
Practice Address - Country:US
Practice Address - Phone:607-761-0885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR027802-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical