MEDICARE: CAROLYN COHEN

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	103T00000X	Psychologist	PY4562PR	MA

General Provider Information

NPI Number	:	1184114209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN COHEN

Provider Business Mailing Address
First Line	:	1675 N MILITARY TRL STE 500
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33486-4321
Country	:	US
Telephone Number	:	617-448-2123
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 OCEAN DR APT 805
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-3132
Country	:	US
Telephone Number	:	617-448-2123
Fax Number	:

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

Provider Enumeration Date	:	05/14/2018
Last Update Date	:	05/14/2018

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Directions to “ CAROLYN COHEN ” Practice Location

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