Provider Demographics
NPI:1023030996
Name:AHO, AMY COHAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:COHAN
Last Name:AHO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OCEANPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07757-1030
Mailing Address - Country:US
Mailing Address - Phone:732-544-0323
Mailing Address - Fax:723-530-1005
Practice Address - Street 1:108 MAIN ST
Practice Address - Street 2:
Practice Address - City:OCEANPORT
Practice Address - State:NJ
Practice Address - Zip Code:07757-1030
Practice Address - Country:US
Practice Address - Phone:732-544-0323
Practice Address - Fax:723-530-1005
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2363103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
626169Medicare ID - Type Unspecified