Provider Demographics
NPI:1154449569
Name:COHAN, JUDY LYNN (LCSW)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:LYNN
Last Name:COHAN
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 1:1517 LORI LYN LN
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4930
Mailing Address - Country:US
Mailing Address - Phone:847-412-9966
Mailing Address - Fax:
Practice Address - Street 1:1517 LORI LYN LN
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4930
Practice Address - Country:US
Practice Address - Phone:847-412-9966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-002051041C0700X
1490025051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149002505OtherLICENSE