Provider Demographics
NPI:1306950928
Name:COHN, STACEY ELIZABETH (LCSW)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:ELIZABETH
Last Name:COHN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:ELIZABETH
Other - Last Name:MARUSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1851 E 1ST ST STE 630
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-4000
Mailing Address - Country:US
Mailing Address - Phone:323-428-1925
Mailing Address - Fax:
Practice Address - Street 1:5479 E ABBEYFIELD ST STE 3
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-3050
Practice Address - Country:US
Practice Address - Phone:562-498-5900
Practice Address - Fax:562-498-5909
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI06000241041C0700X
CA250751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical