Basic Information
| Provider Information | |||||||||
| NPI: | 1487775193 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COHEN | ||||||||
| FirstName: | JUDI | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSWR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 LEROY ST | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | POTSDAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136761786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152653300 | ||||||||
| FaxNumber: | 3152616025 | ||||||||
| Practice Location | |||||||||
| Address1: | 80 STATE HIGHWAY 310 | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | CANTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136171493 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153862167 | ||||||||
| FaxNumber: | 3153862435 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2007 | ||||||||
| LastUpdateDate: | 09/12/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | R049961 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.