Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | AZ | |
Y | 103T00000X | Psychologist | AZ |
NPI | 1003959032 |
---|---|
Provider Name | Mr. Robert M. Cohen |
First Address | Laveen, AZ 85339-2669 |
Second Address | Laveen, AZ 85339-2669 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 26/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
896079 | AHCCCS ID (01) | AZ |