MEDICARE: HANNA COHEN PH.D INC

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	1041C0700X	Clinical Social Worker	34002149A	IN
2	106H00000X	Marriage & Family Therapist	35000615A	IN

General Provider Information

NPI Number	:	1720342975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANNA COHEN PH.D INC

Provider Business Mailing Address
First Line	:	9102 N MERIDIAN ST
Second Line	:	SUITE 525
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1860
Country	:	US
Telephone Number	:	317-574-1157
Fax Number	:	317-580-0509

Provider Business Practice Location Address
First Line	:	9102 N MERIDIAN ST
Second Line	:	SUITE 525
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1860
Country	:	US
Telephone Number	:	317-574-1157
Fax Number	:	317-580-0509

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HANNA ALON COHEN
Credential	:	PH.D
Telephone Number	:	317-574-1157

Provider Enumeration Date	:	07/02/2012
Last Update Date	:	07/02/2012

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Directions to “HANNA COHEN PH.D INC ” Practice Location

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