Provider Demographics
NPI:1710170287
Name:COHEN, VERNANNE EILEEN
Entity Type:Individual
Prefix:MS
First Name:VERNANNE
Middle Name:EILEEN
Last Name:COHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93406-0635
Mailing Address - Country:US
Mailing Address - Phone:805-543-8855
Mailing Address - Fax:805-543-8855
Practice Address - Street 1:1190 MARSH ST STE B
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3332
Practice Address - Country:US
Practice Address - Phone:805-543-8855
Practice Address - Fax:805-543-8855
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-19
Last Update Date:2007-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 41118106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist