Provider Demographics
NPI:1619251287
Name:KENNETH J. COCHRANE, PH.D., LLC
Entity Type:Organization
Organization Name:KENNETH J. COCHRANE, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:COCHRANE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:352-406-5937
Mailing Address - Street 1:5635 CELEBRATION WAY
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-8379
Mailing Address - Country:US
Mailing Address - Phone:352-406-5937
Mailing Address - Fax:407-699-5081
Practice Address - Street 1:5635 CELEBRATION WAY
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-8379
Practice Address - Country:US
Practice Address - Phone:352-406-5937
Practice Address - Fax:407-699-5081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8381103TC0700X
NY009300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty