Healthcare Provider Details

I. General information

NPI: 1992868079
Provider Name (Legal Business Name): MAUREEN ELIZABETH COHEN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 HAMPTON POINT DR SUITE 1
ST AUGUSTINE FL
32092-3053
US

IV. Provider business mailing address

PO BOX 601064
JACKSONVILLE FL
32260-1064
US

V. Phone/Fax

Practice location:
  • Phone: 904-210-8059
  • Fax:
Mailing address:
  • Phone: 904-210-8059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH9968
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: