Provider Demographics
NPI:1033267315
Name:COHEN, SUZANNE L (EDD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:L
Last Name:COHEN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-2710
Mailing Address - Country:US
Mailing Address - Phone:617-694-2098
Mailing Address - Fax:617-332-1793
Practice Address - Street 1:1 HOLLIS ST STE 135
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-4691
Practice Address - Country:US
Practice Address - Phone:781-235-2260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1474103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW01500Medicare ID - Type Unspecified