Healthcare Provider Details

I. General information

NPI: 1023735255
Provider Name (Legal Business Name): BARRY J. COHEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19300 W DIXIE HWY UNIT 2
AVENTURA FL
33180-2201
US

IV. Provider business mailing address

3029 NE QUAYSIDE LN
MIAMI FL
33138-2258
US

V. Phone/Fax

Practice location:
  • Phone: 303-807-6110
  • Fax:
Mailing address:
  • Phone: 303-807-6110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BARRY JASON COHEN
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential: MA
Phone: 303-807-6110