Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | LCS12606 | CA |
NPI | 1003035957 |
---|---|
Provider Name | Susan Debra Cohn |
First Address | Laguna Beach, CA 92651-3663 |
Second Address | Laguna Beach, CA 92651-3663 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 08/07/2007 |