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General NPI Number Information
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NPI Number | 1003470626
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Entity Type | Individual
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Provider Name | ELISE COHEN
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Gender | Female
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Dates
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Enumeration Date | 04/29/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 859 WILLARD ST
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City | QUINCY
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State | MA
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Zip | 02169-7482
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Country | US
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Telephone | 703-615-0212
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Fax |
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Provider Business Mailing Address
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Address Line | 21050 41ST AVE APT 5C
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City | BAYSIDE
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State | NY
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Zip | 11361-1916
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Country | US
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Telephone | 703-615-0212
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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