Provider Demographics
NPI:1760550255
Name:COHEN, ROBERT BRUCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRUCE
Last Name:COHEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14007 WOODENS LN
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-4536
Mailing Address - Country:US
Mailing Address - Phone:410-429-2998
Mailing Address - Fax:
Practice Address - Street 1:8813 WALTHAM WOODS RD
Practice Address - Street 2:SUITE 302
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-2450
Practice Address - Country:US
Practice Address - Phone:410-665-4522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2010-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02388103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD001341OtherVALUE OPTIONS
MD005980300Medicaid
MD222993OtherCOMP PSYCH
MD5359781OtherAETNA
MD100033107001OtherAPS
MD367826OtherMAMSI, MDIPA, OPTIMUM CHO
MDM0050001OtherFED BLUE SHIELD, BLUE CHO
MD226762OtherKAISER
MD005980300Medicaid
MD001341OtherVALUE OPTIONS