Provider Demographics
NPI:1003959032
Name:COHEN, ROBERT M (MA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:M
Last Name:COHEN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7215 W ALTA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2669
Mailing Address - Country:US
Mailing Address - Phone:480-437-4301
Mailing Address - Fax:
Practice Address - Street 1:7215 W ALTA VISTA RD
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-2669
Practice Address - Country:US
Practice Address - Phone:480-437-4301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ896079OtherAHCCCS ID