Provider Demographics
NPI:1346643996
Name:NANCY G COHEN
Entity Type:Organization
Organization Name:NANCY G COHEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHILD DEVELOPMENT AND BEHAVIOR SPEC
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:GLASER
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:619-992-0703
Mailing Address - Street 1:12625 HIGH BLUFF DR STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2053
Mailing Address - Country:US
Mailing Address - Phone:619-992-0703
Mailing Address - Fax:
Practice Address - Street 1:12625 HIGH BLUFF DR STE 105
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2053
Practice Address - Country:US
Practice Address - Phone:619-992-0703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health