Healthcare Provider Details

I. General information

NPI: 1578211132
Provider Name (Legal Business Name): MEGAN BENNETT COHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MERRITT BLVD STE 25
TRUMBULL CT
06611-5450
US

IV. Provider business mailing address

133 PEACEABLE RIDGE RD
RIDGEFIELD CT
06877-3615
US

V. Phone/Fax

Practice location:
  • Phone: 888-754-0398
  • Fax:
Mailing address:
  • Phone: 203-617-7728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1423
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: