Healthcare Provider Details

I. General information

NPI: 1780631796
Provider Name (Legal Business Name): ROBERT E COHEN PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 W GORE ST 5TH FLOOR
ORLANDO FL
32806-1114
US

IV. Provider business mailing address

32 W GORE ST 5TH FLOOR
ORLANDO FL
32806-1114
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-2452
  • Fax: 407-841-4076
Mailing address:
  • Phone: 321-841-2452
  • Fax: 407-841-4076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY7151
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: