MEDICARE: NOAH HASS-COHEN PSYD PSYCHOLOGY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center
4	103T00000X	Psychologist

General Provider Information

NPI Number	:	1508494659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOAH HASS-COHEN PSYD PSYCHOLOGY, INC.

Provider Business Mailing Address
First Line	:	640 S SAN VICENTE BLVD STE 264
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4884
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	640 S SAN VICENTE BLVD STE 264
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4884
Country	:	US
Telephone Number	:	323-717-6546
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NOAH HASS-COHEN
Credential	:	PSYD
Telephone Number	:	323-717-6546

Provider Enumeration Date	:	04/01/2020
Last Update Date	:	05/13/2021

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