Healthcare Provider Details

I. General information

NPI: 1083529473
Provider Name (Legal Business Name): BENJAMIN WILLIAM COHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 PROSPECT ST
BRISTOL CT
06010-5071
US

IV. Provider business mailing address

27 WATERSIDE LN
WEST HARTFORD CT
06107-3523
US

V. Phone/Fax

Practice location:
  • Phone: 860-929-8553
  • Fax:
Mailing address:
  • Phone: 860-929-8553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: