MEDICARE: GWENDOLYN LIZETTE LOPEZ-COHEN M.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	2084P0804X	Child & Adolescent Psychiatry Physician	239116	NY
2	2084P0804X	Child & Adolescent Psychiatry Physician	047160	CT

General Provider Information

NPI Number	:	1770782476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWENDOLYN LIZETTE LOPEZ-COHEN M.D.

Provider Business Mailing Address
First Line	:	64 POST RD W
Second Line	:	2ND FLOOR
City	:	WESTPORT
State	:	CT
Zip	:	06880-4208
Country	:	US
Telephone Number	:	203-226-2360
Fax Number	:	203-286-1670

Provider Business Practice Location Address
First Line	:	64 POST RD W
Second Line	:	2ND FLOOR
City	:	WESTPORT
State	:	CT
Zip	:	06880-4208
Country	:	US
Telephone Number	:	203-226-2360
Fax Number	:	203-286-1670

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

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	01/13/2016

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