Provider Demographics
NPI:1831176957
Name:COHEN, CONNIE BARBARA (LICSW)
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:BARBARA
Last Name:COHEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 365956
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-0017
Mailing Address - Country:US
Mailing Address - Phone:617-796-2907
Mailing Address - Fax:
Practice Address - Street 1:36 WELLES ST
Practice Address - Street 2:SUITE230
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2080
Practice Address - Country:US
Practice Address - Phone:203-454-6722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1122501041C0700X
CT0028961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical