Provider Demographics
NPI:1235185802
Name:COHEN, WENDY L (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:L
Last Name:COHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:L
Other - Last Name:FABRICANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1415 BEACON ST.
Mailing Address - Street 2:STE. 320
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446
Mailing Address - Country:US
Mailing Address - Phone:617-990-4557
Mailing Address - Fax:617-277-1014
Practice Address - Street 1:1415 BEACON ST.
Practice Address - Street 2:STE. 320
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446
Practice Address - Country:US
Practice Address - Phone:617-990-4557
Practice Address - Fax:617-277-1014
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2274562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000224501Medicare PIN