MEDICARE: AMANDA COHEN

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	106H00000X	Marriage & Family Therapist	MT4805	FL

General Provider Information

NPI Number	:	1821864257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA COHEN

Provider Business Mailing Address
First Line	:	650 SE 4TH CT
Second Line	:
City	:	DANIA BEACH
State	:	FL
Zip	:	33004-4737
Country	:	US
Telephone Number	:	786-202-1197
Fax Number	:

Provider Business Practice Location Address
First Line	:	906 NE 26TH AVE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33304-3607
Country	:	US
Telephone Number	:	786-202-1197
Fax Number	:

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

Provider Enumeration Date	:	11/27/2023
Last Update Date	:	11/27/2023

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Directions to “ AMANDA COHEN ” Practice Location

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