Provider Demographics
NPI:1326154386
Name:COHN, MARILYN R (EDD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:R
Last Name:COHN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 CROSMAN AVE
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-1412
Mailing Address - Country:US
Mailing Address - Phone:978-354-2657
Mailing Address - Fax:978-741-8982
Practice Address - Street 1:70 WASHINGTON ST
Practice Address - Street 2:SUITE 316
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3518
Practice Address - Country:US
Practice Address - Phone:978-354-2657
Practice Address - Fax:978-741-8982
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4910103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO W06318OtherBLUE SHIELD OF MA
MAPO W06318OtherBLUE SHIELD OF MA