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General NPI Number Information
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NPI Number | 1487417705
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Entity Type | Organization
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Legal Business Name | JONATHAN D. COHEN, PH.D.
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Dates
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Enumeration Date | 01/31/2024
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Last Update Date | 01/31/2024
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Provider Practice Location Address
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Address Line | 282 E DUVAL ST
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City | LAKE CITY
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State | FL
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Zip | 32055-4085
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Country | US
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Telephone | 386-288-4734
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Fax |
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Provider Business Mailing Address
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Address Line | 282 E DUVAL ST
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City | LAKE CITY
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State | FL
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Zip | 32055-4085
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Country | US
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Telephone | 386-288-4734
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | JONATHAN COHEN
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Credential |
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Telephone | 386-288-4734
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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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