Provider Demographics
NPI:1437436508
Name:COHEN, JANE BERGMAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:BERGMAN
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 1:192 YUKON DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-3115
Mailing Address - Country:US
Mailing Address - Phone:516-496-0724
Mailing Address - Fax:
Practice Address - Street 1:192 YUKON DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-3115
Practice Address - Country:US
Practice Address - Phone:516-496-0724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool