Healthcare Provider Details

I. General information

NPI: 1164544557
Provider Name (Legal Business Name): LEO COHEN PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 KNOX DR
YARDLEY PA
19067-4424
US

IV. Provider business mailing address

1210 KNOX DR
YARDLEY PA
19067-4424
US

V. Phone/Fax

Practice location:
  • Phone: 215-493-9404
  • Fax: 215-493-9404
Mailing address:
  • Phone: 215-493-9404
  • Fax: 215-493-9404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPS000714L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPS000714L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPS000714L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS000714L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: