Healthcare Provider Details

I. General information

NPI: 1417343393
Provider Name (Legal Business Name): JAMIE ALEXANDER COHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST BWH DEPT. OF PSYCHIATRY
BOSTON MA
02115-6110
US

IV. Provider business mailing address

375 BOYLSTON ST
BROOKLINE MA
02445-6007
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-1029
  • Fax:
Mailing address:
  • Phone: 857-307-0864
  • Fax: 617-394-3209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number277775
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: