MEDICARE: SARA KEALOHA COHEN DNP, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	SP032071	PA

General Provider Information

NPI Number	:	1033903471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA KEALOHA COHEN DNP, PMHNP-BC

Provider Business Mailing Address
First Line	:	119 KINGSLEY ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19127-1708
Country	:	US
Telephone Number	:	610-909-2125
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 SPRUCE ST STE B03
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19106-4038
Country	:	US
Telephone Number	:	215-829-5085
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2025
Last Update Date	:	04/09/2025

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