Provider Demographics
NPI:1558315812
Name:COHEN, BENJAMIN N (PHD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:N
Last Name:COHEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:BENJAMIN
Other - Middle Name:N
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 1546
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34688-1546
Mailing Address - Country:US
Mailing Address - Phone:727-271-3112
Mailing Address - Fax:813-792-7149
Practice Address - Street 1:905 E MARTIN LUTHER KING JR DR STE 211
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-4827
Practice Address - Country:US
Practice Address - Phone:727-271-3112
Practice Address - Fax:727-271-3112
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7056103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292384OtherAMERIGROUP PROVIDER NUMBE
FL7685165Medicaid
FL328173OtherWELLCARE PROVIDER ID
FL7247804OtherAETNA PROVIDER ID
FL7247804OtherAETNA PROVIDER ID