Healthcare Provider Details

I. General information

NPI: 1518036516
Provider Name (Legal Business Name): RALPH S. COHEN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2306 BERLIN TPKE SUITE 101
NEWINGTON CT
06111-3204
US

IV. Provider business mailing address

836 FARMINGTON AVE SUITE 217-B
WEST HARTFORD CT
06119-1505
US

V. Phone/Fax

Practice location:
  • Phone: 860-523-9420
  • Fax: 860-667-3369
Mailing address:
  • Phone: 860-523-9420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number001330
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: