Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist |
NPI | 1003470626 |
---|---|
Provider Name | Elise Cohen |
First Address | Bayside, NY 11361-1916 |
Second Address | Quincy, MA 02169-7482 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2019 |
Last Update Date | 11/06/2019 |