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General NPI Number Information
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NPI Number | 1053690842
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Entity Type | Individual
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Provider Name | JOSHUA IAN COHEN
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Gender | Male
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Dates
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Enumeration Date | 08/10/2011
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | 61 S MAIN ST STE 310
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City | WEST HARTFORD
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State | CT
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Zip | 06107-2403
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Country | US
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Telephone | 860-995-6838
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Fax |
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Provider Business Mailing Address
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Address Line | 16 DEVONSHIRE DR
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-2263
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Country | US
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Telephone | 860-995-6838
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1606
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License Number State | CT
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