Provider Demographics
NPI:1245597574
Name:COHEN, JASON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:COHEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 ROUTE 73 N.
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3445
Mailing Address - Country:US
Mailing Address - Phone:856-452-4969
Mailing Address - Fax:
Practice Address - Street 1:651 ROUTE 73 N.
Practice Address - Street 2:SUITE 110
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3445
Practice Address - Country:US
Practice Address - Phone:856-452-4969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100606900103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical