Provider Demographics
NPI:1952431603
Name:COHEN, KENNETH MITCHELL (LCSW)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:MITCHELL
Last Name:COHEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21634 SONOMA CT
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-1001
Mailing Address - Country:US
Mailing Address - Phone:561-499-6716
Mailing Address - Fax:
Practice Address - Street 1:16244 S MILTARY TR
Practice Address - Street 2:325
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484
Practice Address - Country:US
Practice Address - Phone:561-499-6716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW24321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW2432OtherSTATE LICENSE
FLZ4334ZMedicare ID - Type Unspecified
FLSW2432OtherSTATE LICENSE