Provider Demographics
NPI:1720357528
Name:COHEN, HERBERT STEVEN (EDD)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:STEVEN
Last Name:COHEN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 GUN CLUB RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06903-1024
Mailing Address - Country:US
Mailing Address - Phone:203-968-0469
Mailing Address - Fax:
Practice Address - Street 1:106 GUN CLUB RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06903-1024
Practice Address - Country:US
Practice Address - Phone:203-968-0469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT918103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical