Provider Demographics
NPI:1174643407
Name:COHEN, LYNN
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 CERNON ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-4543
Mailing Address - Country:US
Mailing Address - Phone:707-452-9466
Mailing Address - Fax:
Practice Address - Street 1:348 CERNON ST
Practice Address - Street 2:SUITE E
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4543
Practice Address - Country:US
Practice Address - Phone:707-452-9466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27739106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA106H00000XOtherMFT