Healthcare Provider Details

I. General information

NPI: 1053445304
Provider Name (Legal Business Name): BARRY DANIEL COHEN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12456 VENTURA BLVD STE 1
STUDIO CITY CA
91604-2484
US

IV. Provider business mailing address

9903 SANTA MONICA BLVD # 412
BEVERLY HILLS CA
90212-1606
US

V. Phone/Fax

Practice location:
  • Phone: 310-859-0505
  • Fax:
Mailing address:
  • Phone: 310-859-0505
  • Fax: 310-859-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 5786
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: