Provider Demographics
NPI:1053445304
Name:COHEN, BARRY DANIEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:DANIEL
Last Name:COHEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9777 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 901
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-1910
Mailing Address - Country:US
Mailing Address - Phone:310-859-0505
Mailing Address - Fax:310-859-0505
Practice Address - Street 1:9777 WILSHIRE BLVD
Practice Address - Street 2:SUITE 901
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1910
Practice Address - Country:US
Practice Address - Phone:310-859-0505
Practice Address - Fax:310-859-0505
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 5786103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP5786Medicare ID - Type Unspecified