Provider Demographics
NPI:1033572524
Name:COHEN, FREDA
Entity Type:Individual
Prefix:
First Name:FREDA
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 RIVERSIDE BLVD
Mailing Address - Street 2:APT 3D
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3532
Mailing Address - Country:US
Mailing Address - Phone:917-623-0260
Mailing Address - Fax:
Practice Address - Street 1:310 RIVERSIDE BLVD
Practice Address - Street 2:APT 3D
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3532
Practice Address - Country:US
Practice Address - Phone:917-623-0260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst