1922059054 NPI number — MRS. MELISSA D COHEN LCSW

Table of content: MRS. MELISSA D COHEN LCSW (NPI 1922059054)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922059054 NPI number — MRS. MELISSA D COHEN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COHEN
Provider First Name:
MELISSA
Provider Middle Name:
D
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KEEN
Provider Other First Name:
MELISSA
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922059054
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2507 MINERAL SPRINGS AVE
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37917-1549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-688-0661
Provider Business Mailing Address Fax Number:
865-688-5780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2507 MINERAL SPRINGS AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37917-1549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-688-0661
Provider Business Practice Location Address Fax Number:
865-688-5780
Provider Enumeration Date:
05/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LSW0000003735 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3153468 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3923663 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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