Healthcare Provider Details

I. General information

NPI: 1871982942
Provider Name (Legal Business Name): MICHAEL COHEN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2015
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WALL ST
NORWALK CT
06850-3438
US

IV. Provider business mailing address

10 WALL ST
NORWALK CT
06850-3438
US

V. Phone/Fax

Practice location:
  • Phone: 203-360-2354
  • Fax: 203-381-9396
Mailing address:
  • Phone: 203-360-2354
  • Fax: 203-381-9396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number002689
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number015371
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: