Provider Demographics
NPI:1609870492
Name:COHEN, DANIEL M (PHD)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:M
Last Name:COHEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:MR
Other - First Name:DAN
Other - Middle Name:M
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:512 KAPPOCK ST
Mailing Address - Street 2:2H
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-6404
Mailing Address - Country:US
Mailing Address - Phone:917-796-0498
Mailing Address - Fax:
Practice Address - Street 1:512 KAPPOCK ST
Practice Address - Street 2:2H
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-6404
Practice Address - Country:US
Practice Address - Phone:917-796-0498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013987103T00000X
CO2900103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02146472Medicaid
NYVL4141Medicare ID - Type Unspecified
NY02146472Medicaid