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General NPI Number Information
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NPI Number | 1366474462
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Entity Type | Individual
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Provider Name | CAROLE BLACK COHEN M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 01/16/2016
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Provider Practice Location Address
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Address Line | 10 FOREST PARK DR
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City | FARMINGTON
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State | CT
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Zip | 06032-1499
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Country | US
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Telephone | 860-676-7760
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Fax | 860-675-5619
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Provider Business Mailing Address
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Address Line | 10 FOREST PARK DR
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City | FARMINGTON
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State | CT
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Zip | 06032-1499
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Country | US
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Telephone | 860-676-6670
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Fax | 860-675-5619
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 033139
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License Number State | CT
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