Provider Demographics
NPI:1053775049
Name:COHEN BOERSEMA, PERI (LCSW)
Entity type:Individual
Prefix:
First Name:PERI
Middle Name:
Last Name:COHEN BOERSEMA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7116 HARLAN LN
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-7559
Mailing Address - Country:US
Mailing Address - Phone:443-756-7989
Mailing Address - Fax:
Practice Address - Street 1:7116 HARLAN LN
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-7559
Practice Address - Country:US
Practice Address - Phone:443-756-7989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD170791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical