Provider Demographics
NPI:1689731754
Name:COHAN-DERY, BEHNAZ DEBBIE (MFT)
Entity Type:Individual
Prefix:MRS
First Name:BEHNAZ
Middle Name:DEBBIE
Last Name:COHAN-DERY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5714 BABBITT AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1426
Mailing Address - Country:US
Mailing Address - Phone:818-754-1526
Mailing Address - Fax:
Practice Address - Street 1:16861 VENTURA BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1708
Practice Address - Country:US
Practice Address - Phone:818-754-1526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist