Provider Demographics
NPI:1134291768
Name:COHEN, CHARLES MELVIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MELVIN
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 1:2387 W GATE DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-1623
Mailing Address - Country:US
Mailing Address - Phone:412-367-8480
Mailing Address - Fax:
Practice Address - Street 1:307 4TH AVE
Practice Address - Street 2:SUITE 503
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-2108
Practice Address - Country:US
Practice Address - Phone:412-434-0855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS001631L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist