Healthcare Provider Details

I. General information

NPI: 1669462867
Provider Name (Legal Business Name): ELIZABETH KEATING-COHEN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 HIGH ST SUITE DH-7
MEDFORD MA
02155-3850
US

IV. Provider business mailing address

92 HIGH ST SUITE DH-7
MEDFORD MA
02155-3850
US

V. Phone/Fax

Practice location:
  • Phone: 781-393-8889
  • Fax: 781-396-3948
Mailing address:
  • Phone: 781-393-8889
  • Fax: 781-396-3948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2876
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: