Provider Demographics
NPI:1831250448
Name:COHEN, MICHELE SUSAN (LCSW)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:SUSAN
Last Name:COHEN
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 1:15A SHERIDAN SQUARE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10014
Mailing Address - Country:US
Mailing Address - Phone:212-727-1879
Mailing Address - Fax:
Practice Address - Street 1:15A SHERIDAN SQUARE
Practice Address - Street 2:SUITE 5
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10014
Practice Address - Country:US
Practice Address - Phone:212-727-1879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR027807-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN1A421Medicare ID - Type Unspecified