Healthcare Provider Details

I. General information

NPI: 1346475381
Provider Name (Legal Business Name): NANCY ELLEN COHEN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 05/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 BROADWAY E
SEATTLE WA
98102-5776
US

IV. Provider business mailing address

229 BOYLSTON AVE E
SEATTLE WA
98102-5608
US

V. Phone/Fax

Practice location:
  • Phone: 206-329-1230
  • Fax:
Mailing address:
  • Phone: 206-726-0453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPY00003084
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY00003084
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY00003084
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPY00003084
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: