Healthcare Provider Details

I. General information

NPI: 1871575308
Provider Name (Legal Business Name): DIANE J COHEN CARLSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. DIANE COHEN

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5625 COLLEGE AVE STE 210C
OAKLAND CA
94618-1677
US

IV. Provider business mailing address

5625 COLLEGE AVE STE 210C
OAKLAND CA
94618-1677
US

V. Phone/Fax

Practice location:
  • Phone: 510-653-1464
  • Fax: 510-547-0174
Mailing address:
  • Phone: 510-653-1464
  • Fax: 510-547-0174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY13662
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY13662
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: