Healthcare Provider Details

I. General information

NPI: 1811476906
Provider Name (Legal Business Name): JONAH COHEN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOWDOIN SQ FL 6
BOSTON MA
02114
US

IV. Provider business mailing address

1 BOWDOIN SQ FL 6
BOSTON MA
02114-2927
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-8895
  • Fax:
Mailing address:
  • Phone: 617-726-8895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number10844
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: