Healthcare Provider Details

I. General information

NPI: 1396265815
Provider Name (Legal Business Name): SHEREEN JESSICA COHEN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 S. MELROSE DR. STE A #384
VISTA CA
92081-5407
US

IV. Provider business mailing address

1611 S. MELROSE DR. STE A #384
VISTA CA
92081-5407
US

V. Phone/Fax

Practice location:
  • Phone: 858-465-6495
  • Fax: 858-726-8996
Mailing address:
  • Phone: 858-465-6495
  • Fax: 858-726-8996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number33079
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: