MEDICARE: MONYA COHEN PSYD LLC

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

General Provider Information

NPI Number	:	1417566738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONYA COHEN PSYD LLC

Provider Business Mailing Address
First Line	:	2407 PONDSIDE TER
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20906-5752
Country	:	US
Telephone Number	:	301-598-0636
Fax Number	:

Provider Business Practice Location Address
First Line	:	2407 PONDSIDE TER
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20906-5752
Country	:	US
Telephone Number	:	301-598-0636
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MONYA JO COHEN
Credential	:	PSY.D.
Telephone Number	:	202-255-7180

Provider Enumeration Date	:	07/23/2020
Last Update Date	:	07/23/2020

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