Provider Demographics
NPI:1710345376
Name:COHEN, LESLIE ROBIN (BCBA-D, PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ROBIN
Last Name:COHEN
Suffix:
Gender:F
Credentials:BCBA-D, PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-1606
Mailing Address - Country:US
Mailing Address - Phone:413-320-2451
Mailing Address - Fax:866-333-0748
Practice Address - Street 1:1 GRANT ST
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-1606
Practice Address - Country:US
Practice Address - Phone:413-320-2451
Practice Address - Fax:866-333-0748
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-03-1111103K00000X
NY07566-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist