MEDICARE: MRS. LAURA A COHEN PH.D.,P.A.

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	103TC0700X	Clinical Psychologist	PY0005832	FL
2	103T00000X	Psychologist	PY5632	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730176892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA A COHEN PH.D.,P.A.

Provider Business Mailing Address
First Line	:	2699 STIRLING RD
Second Line	:	SUITE C304
City	:	HOLLYWOOD
State	:	FL
Zip	:	33312-6517
Country	:	US
Telephone Number	:	954-893-7110
Fax Number	:	954-893-1105

Provider Business Practice Location Address
First Line	:	2699 STIRLING RD
Second Line	:	SUITE C304
City	:	HOLLYWOOD
State	:	FL
Zip	:	33312-6517
Country	:	US
Telephone Number	:	954-893-7110
Fax Number	:	954-893-1105

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	02/21/2014

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