Provider Demographics
NPI:1194882803
Name:COGAN, SHARON A (LCSWR)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:A
Last Name:COGAN
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 W 96TH ST
Mailing Address - Street 2:APT. 19F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6200
Mailing Address - Country:US
Mailing Address - Phone:914-423-4433
Mailing Address - Fax:914-423-9434
Practice Address - Street 1:275 W 96TH ST
Practice Address - Street 2:APT. 19F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6200
Practice Address - Country:US
Practice Address - Phone:914-423-4433
Practice Address - Fax:914-423-9434
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0259781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY229534OtherHEALTHNET
NYN96571Medicare ID - Type Unspecified