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General NPI Number Information
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NPI Number | 1225859531
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Entity Type | Individual
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Provider Name | LEE G COHEN PSYD
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Gender | Male
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Dates
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Enumeration Date | 10/19/2024
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Last Update Date | 10/19/2024
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Provider Practice Location Address
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Address Line | 45 RIVER RD
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City | SUMMIT
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State | NJ
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Zip | 07901-1452
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Country | US
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Telephone | 973-314-8773
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Fax |
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Provider Business Mailing Address
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Address Line | 20 CHEROKEE RD
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City | CRANFORD
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State | NJ
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Zip | 07016-3358
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Country | US
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Telephone | 908-202-0174
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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 | TP243-056
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License Number State | NJ
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