MEDICARE: DR. JUDITH RUTH COHEN PHD

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	101YP2500X	Professional Counselor		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01627272	OTHER	IL	BLUE CROSS/BLUE SHIELD
2	7313430	OTHER	IL	AETNA

General Provider Information

NPI Number	:	1720056419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDITH RUTH COHEN PHD

Provider Business Mailing Address
First Line	:	1350 N LAKE SHORE DR
Second Line	:	APARTMENT 2017
City	:	CHICAGO
State	:	IL
Zip	:	60610-5267
Country	:	US
Telephone Number	:	312-932-9006
Fax Number	:

Provider Business Practice Location Address
First Line	:	6041 1/2 N CICERO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-4301
Country	:	US
Telephone Number	:	773-539-3509
Fax Number	:

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	07/08/2007

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