MEDICARE: DR. JEREMY 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	071.009866	IL

General Provider Information

NPI Number	:	1326799800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY COHEN PH.D.

Provider Business Mailing Address
First Line	:	2334 W LAWRENCE AVE STE 216
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-1033
Country	:	US
Telephone Number	:	312-600-8310
Fax Number	:

Provider Business Practice Location Address
First Line	:	2334 W LAWRENCE AVE STE 216
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-1033
Country	:	US
Telephone Number	:	312-600-8310
Fax Number	:

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

Provider Enumeration Date	:	01/16/2022
Last Update Date	:	03/03/2026

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