MEDICARE: DR. REBECCA ANN COHEN PSYD

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	003385	CT
2	103TC0700X	Clinical Psychologist	003385	CT
3	103TC2200X	Clinical Child & Adolescent Psychologist	003385	CT
4	103TF0000X	Family Psychologist	003385	CT

General Provider Information

NPI Number	:	1558561761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REBECCA ANN COHEN PSYD

Provider Business Mailing Address
First Line	:	21 HAZEL TER
Second Line	:	SUITE B
City	:	WOODBRIDGE
State	:	CT
Zip	:	06525-2209
Country	:	US
Telephone Number	:	203-747-8734
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 HAZEL TER
Second Line	:	SUITE B
City	:	WOODBRIDGE
State	:	CT
Zip	:	06525-2209
Country	:	US
Telephone Number	:	203-747-8734
Fax Number	:

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

Provider Enumeration Date	:	07/25/2007
Last Update Date	:	10/15/2014

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