Provider Demographics
NPI:1073893145
Name:COHEN, RAFAEL MUIR (MA)
Entity Type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:MUIR
Last Name:COHEN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 RAYMOND AVE STE 240
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1525
Mailing Address - Country:US
Mailing Address - Phone:917-697-3462
Mailing Address - Fax:
Practice Address - Street 1:821 RAYMOND AVE STE 240
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1525
Practice Address - Country:US
Practice Address - Phone:917-697-3462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001237221700000X
MNCC01349101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist