Provider Demographics
NPI:1013415207
Name:COHEN, ERIC R
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:R
Last Name:COHEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8080 OLD YORK RD STE 225
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1431
Mailing Address - Country:US
Mailing Address - Phone:215-604-1109
Mailing Address - Fax:
Practice Address - Street 1:8080 OLD YORK RD STE 225
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1431
Practice Address - Country:US
Practice Address - Phone:215-604-1109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist