Provider Demographics
NPI:1225382245
Name:COHEN, JARED CHARLES (RASI)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:CHARLES
Last Name:COHEN
Suffix:
Gender:M
Credentials:RASI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2587
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-0587
Mailing Address - Country:US
Mailing Address - Phone:707-571-2215
Mailing Address - Fax:
Practice Address - Street 1:429 SPEERS RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-3123
Practice Address - Country:US
Practice Address - Phone:707-571-2215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)