Provider Demographics
NPI:1619006624
Name:COHEN, JANE (MSW)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ORCHARD ST STE 301
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5365
Mailing Address - Country:US
Mailing Address - Phone:203-777-6610
Mailing Address - Fax:
Practice Address - Street 1:200 ORCHARD ST STE 301
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5365
Practice Address - Country:US
Practice Address - Phone:203-777-6610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001065106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist