Provider Demographics
NPI:1326489006
Name:COHEN, ISAAC (MFT INTERN #IMF68100)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:COHEN
Suffix:
Gender:M
Credentials:MFT INTERN #IMF68100
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT INTERN #IMF68100
Mailing Address - Street 1:17337 VENTURA BLVD
Mailing Address - Street 2:#327
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3903
Mailing Address - Country:US
Mailing Address - Phone:818-804-4259
Mailing Address - Fax:
Practice Address - Street 1:17337 VENTURA BLVD
Practice Address - Street 2:#327
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3903
Practice Address - Country:US
Practice Address - Phone:818-804-4259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist