Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY000925 | GA |
Y | 103TC0700X | Clinical Psychologist | PSY000925 | GA |
N | 102L00000X | Psychologist | PSY000925 | GA |
N | 103T00000X | Psychologist | PSY000925 | GA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY000925 | GA |
N | 103TM1800X | Intellectual & Developmental Disabilities | PSY000925 | GA |
N | 103TS0200X | School Psychologist | PSY000925 | GA |
NPI | 1053414995 |
---|---|
Provider Name | Morris J. Cohen |
First Address | Augusta, GA 30901-2602 |
Second Address | Augusta, GA 30912-0004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 31/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000269101A | (05) | GA |