Provider Demographics
NPI:1356491070
Name:COHEN, NANCY SARAH (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:SARAH
Last Name:COHEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2043 NAUDAIN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1316
Mailing Address - Country:US
Mailing Address - Phone:215-985-9336
Mailing Address - Fax:215-985-9336
Practice Address - Street 1:2043 NAUDAIN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1316
Practice Address - Country:US
Practice Address - Phone:215-985-9336
Practice Address - Fax:215-985-9336
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007799L103TC0700X
PAMF000370103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA570374Medicare ID - Type Unspecified
PA192608OtherMHN NETWORK PROVIDER ID