Healthcare Provider Details

I. General information

NPI: 1497464366
Provider Name (Legal Business Name): EMMA JILL COHEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 STEELE BLVD STE 2
BERLIN CT
06037-2363
US

IV. Provider business mailing address

54 OAK ST APT 13
MIDDLETOWN CT
06457-3758
US

V. Phone/Fax

Practice location:
  • Phone: 860-909-8569
  • Fax:
Mailing address:
  • Phone: 203-969-4954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5312
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6246
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: