Provider Demographics
NPI:1578582102
Name:COHEN, ROBERTA M (MFT)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:M
Last Name:COHEN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6352
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92846-6352
Mailing Address - Country:US
Mailing Address - Phone:949-552-5600
Mailing Address - Fax:714-894-6850
Practice Address - Street 1:4010 BARRANCA PKWY STE 270
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-1724
Practice Address - Country:US
Practice Address - Phone:949-552-5600
Practice Address - Fax:714-894-6850
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28589106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist