MEDICARE: RONA L COHEN LCMHC

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	101Y00000X	Counselor	068-0000346	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00039903	OTHER	VT	BC BS PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578610655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONA L COHEN LCMHC

Provider Business Mailing Address
First Line	:	PO BOX 527
Second Line	:
City	:	ENOSBURG FALLS
State	:	VT
Zip	:	05450-0527
Country	:	US
Telephone Number	:	802-933-5553
Fax Number	:	802-658-0216

Provider Business Practice Location Address
First Line	:	35 CATHERINE ST
Second Line	:
City	:	SAINT ALBANS
State	:	VT
Zip	:	05478-2205
Country	:	US
Telephone Number	:	802-658-0040
Fax Number	:	802-658-0216

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	07/09/2007

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