Provider Demographics
NPI:1578713509
Name:COHEN, RICHARD M (LIC AC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:COHEN
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 PINE ST
Mailing Address - Street 2:BOX 478
Mailing Address - City:REHOBOTH
Mailing Address - State:MA
Mailing Address - Zip Code:02769-1424
Mailing Address - Country:US
Mailing Address - Phone:508-252-3608
Mailing Address - Fax:
Practice Address - Street 1:245 WINTHROP ST
Practice Address - Street 2:
Practice Address - City:REHOBOTH
Practice Address - State:MA
Practice Address - Zip Code:02769-1819
Practice Address - Country:US
Practice Address - Phone:508-252-3608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238020171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist