Provider Demographics
NPI:1194857458
Name:COHEN-MAITRE, STACEY ANN
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:ANN
Last Name:COHEN-MAITRE
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:STACEY
Other - Middle Name:ANN
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:18421 SANDRINGHAM CT
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-2042
Mailing Address - Country:US
Mailing Address - Phone:818-987-8320
Mailing Address - Fax:818-832-1050
Practice Address - Street 1:18421 SANDRINGHAM CT
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91326-2042
Practice Address - Country:US
Practice Address - Phone:818-987-8320
Practice Address - Fax:818-832-1050
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19834103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist