Healthcare Provider Details

I. General information

NPI: 1578636486
Provider Name (Legal Business Name): MARTIN V COHEN PSYCHOLOGICAL COUNSELING CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S BARRINGTON AVE SUITE 307
LOS ANGELES CA
90025
US

IV. Provider business mailing address

2001 S BARRINGTON AVE SUITE 307
LOS ANGELES CA
90025
US

V. Phone/Fax

Practice location:
  • Phone: 310-478-5888
  • Fax: 310-478-1101
Mailing address:
  • Phone: 310-478-5888
  • Fax: 310-478-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY21166
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC8175
License Number StateCA

VIII. Authorized Official

Name: MARTIN V COHEN
Title or Position: PSYCHOLOGIST PRESIDENT OF CORP
Credential: PHD
Phone: 310-478-5888