Healthcare Provider Details

I. General information

NPI: 1548479348
Provider Name (Legal Business Name): LISA COHEN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 06/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 UNION ST LYNN COMMUNITY HEALTH CENTER- STAR PROGRAM
LYNN MA
01901-1314
US

IV. Provider business mailing address

400 WASHINGTON ST UNIT 102
SOMERVILLE MA
02143-3849
US

V. Phone/Fax

Practice location:
  • Phone: 781-691-7145
  • Fax:
Mailing address:
  • Phone: 617-702-2932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number9712
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: