MEDICARE: MAUREEN COHEN, LICENSED MENTAL HEALTH COUNSELOR

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	101YM0800X	Mental Health Counselor	MH9968	FL

General Provider Information

NPI Number	:	1184017972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAUREEN COHEN, LICENSED MENTAL HEALTH COUNSELOR

Provider Business Mailing Address
First Line	:	PO BOX 601064
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32260-1064
Country	:	US
Telephone Number	:	904-210-8059
Fax Number	:

Provider Business Practice Location Address
First Line	:	157 HAMPTON POINT DR
Second Line	:	SUITE 1
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32092-3053
Country	:	US
Telephone Number	:	904-210-8059
Fax Number	:

Authorized Official
Title or Position	:	LMHC
Name	:	MAUREEN COHEN
Credential	:
Telephone Number	:	904-210-8059

Provider Enumeration Date	:	03/18/2015
Last Update Date	:	03/18/2015

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