Healthcare Provider Details

I. General information

NPI: 1043632912
Provider Name (Legal Business Name): LINDA COHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2014
Last Update Date: 10/01/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 BEAR PAW TRL. OPTIONAL
EAST TAUNTON MA
02718
US

IV. Provider business mailing address

32 BEAR PAW TRAIL OPTIONAL
EAST TAUNTON MA
02718-2530
US

V. Phone/Fax

Practice location:
  • Phone: 508-272-1391
  • Fax:
Mailing address:
  • Phone: 508-272-1391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10427
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: