=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356491070
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NANCY SARAH COHEN PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2007
-----------------------------------------------------
Last Update Date | 02/06/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2043 NAUDAIN ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19146-1316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-985-9336
-----------------------------------------------------
Fax | 215-985-9336
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2043 NAUDAIN ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19146-1316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-985-9336
-----------------------------------------------------
Fax | 215-985-9336
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PS007799L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TF0000X
-----------------------------------------------------
Taxonomy Name | Family Psychologist
-----------------------------------------------------
License Number | MF000370
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------