Healthcare Provider Details

I. General information

NPI: 1801145099
Provider Name (Legal Business Name): EMILY ALISSA COSIN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2012
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 4TH ST
PETALUMA CA
94952-3043
US

IV. Provider business mailing address

7 4TH ST STE 28
PETALUMA CA
94952-7406
US

V. Phone/Fax

Practice location:
  • Phone: 617-665-1183
  • Fax:
Mailing address:
  • Phone: 707-242-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY34465
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: