MEDICARE: MS. MICHELLE 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	21127	CA

General Provider Information

NPI Number	:	1326148230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE COHEN PH.D.

Provider Business Mailing Address
First Line	:	22287 MULHOLLAND HWY
Second Line	:	#214
City	:	CALABASAS
State	:	CA
Zip	:	91302-5157
Country	:	US
Telephone Number	:	310-473-2060
Fax Number	:	310-473-0250

Provider Business Practice Location Address
First Line	:	2001 S BARRINGTON AVE
Second Line	:	#304
City	:	WEST LOS ANGELES
State	:	CA
Zip	:	90025-5363
Country	:	US
Telephone Number	:	310-473-2060
Fax Number	:	310-473-0250

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	07/08/2007

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