Provider Demographics
NPI:1639121585
Name:COHEN, STUART J (PHD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:J
Last Name:COHEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 MERBROOK LN
Mailing Address - Street 2:
Mailing Address - City:MERION
Mailing Address - State:PA
Mailing Address - Zip Code:19066-1617
Mailing Address - Country:US
Mailing Address - Phone:610-664-5805
Mailing Address - Fax:610-664-5246
Practice Address - Street 1:97 MERBROOK LN
Practice Address - Street 2:
Practice Address - City:MERION
Practice Address - State:PA
Practice Address - Zip Code:19066-1617
Practice Address - Country:US
Practice Address - Phone:610-664-5805
Practice Address - Fax:610-664-5246
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS000715103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAR06096Medicare UPIN
PA106201Medicare ID - Type Unspecified