Healthcare Provider Details

I. General information

NPI: 1508578071
Provider Name (Legal Business Name): SHANNON MAE COHEN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2022
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 HUGHES ST
MAPLEWOOD NJ
07040-3304
US

IV. Provider business mailing address

54 HUGHES ST
MAPLEWOOD NJ
07040-3304
US

V. Phone/Fax

Practice location:
  • Phone: 856-425-0913
  • Fax: 856-425-0913
Mailing address:
  • Phone: 856-425-0913
  • Fax: 856-425-0913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number025427
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: