Provider Demographics
NPI:1013044742
Name:COHEN, MARLENE CRESCI (PHD, PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:CRESCI
Last Name:COHEN
Suffix:
Gender:F
Credentials:PHD, PSYCHOLOGIST
Other - Prefix:
Other - First Name:MARLENE
Other - Middle Name:CRESCI
Other - Last Name:ADAIR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1412 RIVEROAKS DR.
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356
Mailing Address - Country:US
Mailing Address - Phone:209-545-3657
Mailing Address - Fax:209-545-3657
Practice Address - Street 1:1015 12TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-0838
Practice Address - Country:US
Practice Address - Phone:209-522-2992
Practice Address - Fax:209-522-2993
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11616103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OPL116160Medicare ID - Type Unspecified