Provider Demographics
NPI:1710038278
Name:COHEN, KIM LESLIE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:LESLIE
Last Name:COHEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 FARNHAM RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1317
Mailing Address - Country:US
Mailing Address - Phone:860-233-3161
Mailing Address - Fax:
Practice Address - Street 1:2306 BERLIN TPKE
Practice Address - Street 2:SUITE 101
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-3204
Practice Address - Country:US
Practice Address - Phone:860-523-9420
Practice Address - Fax:860-667-3369
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001011106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001011OtherLMFT LICENSE
CT001011OtherLMFT LICENSE