Provider Demographics
NPI:1518036516
Name:COHEN, RALPH S (PHD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:S
Last Name:COHEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 FARMINGTON AVE
Mailing Address - Street 2:SUITE 217-B
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1505
Mailing Address - Country:US
Mailing Address - Phone:860-523-9420
Mailing Address - Fax:
Practice Address - Street 1:2306 BERLIN TPKE
Practice Address - Street 2:SUITE 101
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-3204
Practice Address - Country:US
Practice Address - Phone:860-523-9420
Practice Address - Fax:860-667-3369
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001330103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001330OtherPSYCHOLOGIST LICENSE
CT680000217Medicare ID - Type UnspecifiedMEDICARE NUMBER