Provider Demographics
NPI:1174733679
Name:COHEN, DIANE ALAINE (LICSW)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:ALAINE
Last Name:COHEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 AMHERST AVE
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-3170
Mailing Address - Country:US
Mailing Address - Phone:617-852-1097
Mailing Address - Fax:
Practice Address - Street 1:144 AMHERST AVE
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-3170
Practice Address - Country:US
Practice Address - Phone:617-852-1097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1109541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA501887OtherVALUE OPTIONS
MA(CO)PO7274OtherBLUE CROSS BLUE SHIELD
MA412798OtherMAGELLAN
MA1891944Medicaid
MA501887OtherVALUE OPTIONS