MEDICARE: DR. MARK WILLIAM COHEN PH.D.

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	103TC0700X	Clinical Psychologist	3419	OH

General Provider Information

NPI Number	:	1225018187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK WILLIAM COHEN PH.D.

Provider Business Mailing Address
First Line	:	503 N FORT THOMAS AVE
Second Line	:
City	:	FORT THOMAS
State	:	KY
Zip	:	41075-1505
Country	:	US
Telephone Number	:	859-781-4205
Fax Number	:

Provider Business Practice Location Address
First Line	:	48 E HOLLISTER ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-1704
Country	:	US
Telephone Number	:	513-651-5605
Fax Number	:

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

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	07/09/2007

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