Provider Demographics
NPI:1497084966
Name:COCHRAN, JEREMY (MA)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:COCHRAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:SECANE
Mailing Address - State:PA
Mailing Address - Zip Code:19018-3309
Mailing Address - Country:US
Mailing Address - Phone:317-626-6529
Mailing Address - Fax:
Practice Address - Street 1:715 HICKORY RD
Practice Address - Street 2:
Practice Address - City:SECANE
Practice Address - State:PA
Practice Address - Zip Code:19018-3309
Practice Address - Country:US
Practice Address - Phone:317-626-6529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-13
Last Update Date:2009-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst