Provider Demographics
NPI:1003034992
Name:COGSWELL, PETER ALEX (PHD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ALEX
Last Name:COGSWELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:COGSWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1028 MAIN STREET
Mailing Address - Street 2:CHILDREN'S PSYCHIATRY CLINIC
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202
Mailing Address - Country:US
Mailing Address - Phone:716-859-5484
Mailing Address - Fax:
Practice Address - Street 1:1028 MAIN STREET
Practice Address - Street 2:CHILDREN'S PSYCHIATRY CLINIC
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202
Practice Address - Country:US
Practice Address - Phone:716-859-5484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018463103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical