Provider Demographics
NPI:1194212670
Name:COHEN, SHAUN (LMHC)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:
Last Name:COHEN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 SAINT JAMES ST FL 2
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4513
Mailing Address - Country:US
Mailing Address - Phone:917-470-9224
Mailing Address - Fax:
Practice Address - Street 1:79 SAINT JAMES ST FL 2
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4513
Practice Address - Country:US
Practice Address - Phone:917-470-9224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009599101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health