Provider Demographics
NPI:1134670995
Name:COHEN, IRIS (MA)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22639 OAKCREST CT
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-0830
Mailing Address - Country:US
Mailing Address - Phone:408-568-6443
Mailing Address - Fax:
Practice Address - Street 1:1000 FREMONT AVE
Practice Address - Street 2:# 275
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-6093
Practice Address - Country:US
Practice Address - Phone:408-430-3401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93750106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist