Provider Demographics
NPI:1629187349
Name:COHEN, AMY NEUBAUER (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:NEUBAUER
Last Name:COHEN
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Gender:F
Credentials:PHD
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Mailing Address - Street 1:1102 11TH ST
Mailing Address - Street 2:APT 201
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5322
Mailing Address - Country:US
Mailing Address - Phone:310-478-3711
Mailing Address - Fax:310-268-4056
Practice Address - Street 1:11301 WILSHIRE BLVD
Practice Address - Street 2:MIRECC; BLDG 210; ROOM 130
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073-1003
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:310-268-4056
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY18952103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical