Provider Demographics
NPI:1831271691
Name:COHEN, REBECCA M (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:COHEN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BERKSHIRE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1361
Mailing Address - Country:US
Mailing Address - Phone:203-733-6018
Mailing Address - Fax:
Practice Address - Street 1:15 BERKSHIRE RD
Practice Address - Street 2:SUITE B
Practice Address - City:SANDY HOOK
Practice Address - State:CT
Practice Address - Zip Code:06482-1361
Practice Address - Country:US
Practice Address - Phone:203-733-6018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0052691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT005269OtherUBH IND ID
CT9378400OtherPHCS IND ID
CT004125862Medicaid
CT061082115OtherAETNA BEHAVIIRAL HEALTH
CT140005269CT01OtherANTHEM BSBC CT
CT77ABH0020CT01OtherANTHEM BH CLINIC ID
CT304506OtherMHN IND ID
CTANC1319OtherOXFORD PIN CLINIC
CTANC1319OtherOXFORD PIN CLINIC