Provider Demographics
NPI:1164544557
Name:COHEN, LEO (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:
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 1:1210 KNOX DR
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-4424
Mailing Address - Country:US
Mailing Address - Phone:215-493-9404
Mailing Address - Fax:215-493-9404
Practice Address - Street 1:1210 KNOX DR
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-4424
Practice Address - Country:US
Practice Address - Phone:215-493-9404
Practice Address - Fax:215-493-9404
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS000714L103TC0700X, 103TA0700X, 103TB0200X, 103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0003126Medicare ID - Type UnspecifiedMEDICARE