MEDICARE: DR. PHYLLIS 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	103TC0700X	Clinical Psychologist	009302-1	NY

General Provider Information

NPI Number	:	1306989389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHYLLIS COHEN PH.D.

Provider Business Mailing Address
First Line	:	3701 BEDFORD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1703
Country	:	US
Telephone Number	:	718-253-1295
Fax Number	:	718-692-1059

Provider Business Practice Location Address
First Line	:	3701 BEDFORD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1703
Country	:	US
Telephone Number	:	718-253-1295
Fax Number	:	718-692-1059

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

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/08/2007

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