Provider Demographics
NPI:1386423317
Name:COHEN, SAMUEL (LSW)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:COHEN
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 S ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-5840
Mailing Address - Country:US
Mailing Address - Phone:847-691-1779
Mailing Address - Fax:
Practice Address - Street 1:663 S ACADEMY ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-5840
Practice Address - Country:US
Practice Address - Phone:847-691-1779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.1113071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical