Provider Demographics
NPI:1962625731
Name:COHEN, ILANA R (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ILANA
Middle Name:R
Last Name:COHEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ILANA
Other - Middle Name:R
Other - Last Name:NOMBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2541 CANYON OAK DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-2429
Mailing Address - Country:US
Mailing Address - Phone:323-461-6167
Mailing Address - Fax:
Practice Address - Street 1:2541 CANYON OAK DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-2429
Practice Address - Country:US
Practice Address - Phone:323-461-6167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA226211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical