Healthcare Provider Details

I. General information

NPI: 1700891173
Provider Name (Legal Business Name): LYDIA J COHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E VAN BUREN ST
PHOENIX AZ
85006-3742
US

IV. Provider business mailing address

PO BOX 14631
SCOTTSDALE AZ
85267-4631
US

V. Phone/Fax

Practice location:
  • Phone: 480-205-1786
  • Fax:
Mailing address:
  • Phone: 480-205-1786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20724
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number20724
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: