Provider Demographics
NPI:1598853350
Name:COHEN, MICHELE
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2999 NE 191ST ST
Mailing Address - Street 2:SUITE 701
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3123
Mailing Address - Country:US
Mailing Address - Phone:305-653-0098
Mailing Address - Fax:
Practice Address - Street 1:2999 NE 191ST ST
Practice Address - Street 2:SUITE 701
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3123
Practice Address - Country:US
Practice Address - Phone:305-653-0098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004199103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73685Medicare ID - Type Unspecified
FL650327603Medicare UPIN