Provider Demographics
NPI:1336972850
Name:COHEN, MIRA KAYE (LMSW)
Entity type:Individual
Prefix:
First Name:MIRA
Middle Name:KAYE
Last Name:COHEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 FAIRVIEW ST APT B2
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1880
Mailing Address - Country:US
Mailing Address - Phone:781-364-0671
Mailing Address - Fax:
Practice Address - Street 1:34 FAIRVIEW ST APT B2
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1880
Practice Address - Country:US
Practice Address - Phone:781-364-0671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10162104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker