MEDICARE: AMY PAIGE COHEN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275946592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY PAIGE COHEN PH.D.

Provider Business Mailing Address
First Line	:	505 E GREEN ST
Second Line	:
City	:	URBANA
State	:	IL
Zip	:	61802-3405
Country	:	US
Telephone Number	:	217-265-6937
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 E GREEN ST
Second Line	:
City	:	URBANA
State	:	IL
Zip	:	61802-3405
Country	:	US
Telephone Number	:	217-265-6937
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2014
Last Update Date	:	01/20/2017

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