Provider Demographics
NPI:1306262027
Name:COHEN, ROBERTA (MED, LCADC)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:MED, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 CANNON RD
Mailing Address - Street 2:
Mailing Address - City:COLESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20904-3323
Mailing Address - Country:US
Mailing Address - Phone:301-613-8612
Mailing Address - Fax:
Practice Address - Street 1:705 CANNON RD
Practice Address - Street 2:
Practice Address - City:COLESVILLE
Practice Address - State:MD
Practice Address - Zip Code:20904-3323
Practice Address - Country:US
Practice Address - Phone:301-613-8612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA1709101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)