Provider Demographics
NPI:1194029330
Name:COHEN, LINDSEY L (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:L
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 1:140 DECATUR ST SE DEPT OF
Mailing Address - Street 2:GEORGIA STATE UNIVERSITY
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303
Mailing Address - Country:US
Mailing Address - Phone:404-413-6263
Mailing Address - Fax:
Practice Address - Street 1:675 SEMINOLE AVE NE
Practice Address - Street 2:SUITE 107
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-3408
Practice Address - Country:US
Practice Address - Phone:404-413-6263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002870103TB0200X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPSY002870OtherSTATE OF GEORGIA, PSYCHOLOGIST LICENSURE