Provider Demographics
NPI:1518115914
Name:COHN, MICHAEL S (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:COHN
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 1:15868 CASTAIC RD
Mailing Address - Street 2:# 168
Mailing Address - City:CASTAIC
Mailing Address - State:CA
Mailing Address - Zip Code:91384-3943
Mailing Address - Country:US
Mailing Address - Phone:310-601-7657
Mailing Address - Fax:
Practice Address - Street 1:31858 CASTAIC RD
Practice Address - Street 2:168
Practice Address - City:CASTAIC
Practice Address - State:CA
Practice Address - Zip Code:91384-3943
Practice Address - Country:US
Practice Address - Phone:310-601-7657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6064103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist