Provider Demographics
NPI:1154849776
Name:COHEN, ABBIE LYNN (MFT)
Entity Type:Individual
Prefix:
First Name:ABBIE
Middle Name:LYNN
Last Name:COHEN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 TULIP CT
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510
Mailing Address - Country:US
Mailing Address - Phone:707-315-0771
Mailing Address - Fax:
Practice Address - Street 1:628 2ND AVE SUITE 206
Practice Address - Street 2:
Practice Address - City:CROCKETT
Practice Address - State:CA
Practice Address - Zip Code:94525
Practice Address - Country:US
Practice Address - Phone:707-315-0771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-04
Last Update Date:2017-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT91047106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist