Provider Demographics
NPI:1487645099
Name:COHEN, JO ANN P (PHD)
Entity Type:Individual
Prefix:DR
First Name:JO ANN
Middle Name:P
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 1:1216 DARBY RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-3603
Mailing Address - Country:US
Mailing Address - Phone:610-446-9669
Mailing Address - Fax:610-446-4912
Practice Address - Street 1:1216 DARBY RD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-3603
Practice Address - Country:US
Practice Address - Phone:610-446-9669
Practice Address - Fax:610-446-4912
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006366L103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016126650001Medicaid