Provider Demographics
NPI:1891776134
Name:COHEN, JULIA BETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:BETH
Last Name:COHEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:BETH
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:30011 IVY GLENN DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-5014
Mailing Address - Country:US
Mailing Address - Phone:949-859-8335
Mailing Address - Fax:949-249-1993
Practice Address - Street 1:30011 IVY GLENN DR
Practice Address - Street 2:SUITE 206
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-5014
Practice Address - Country:US
Practice Address - Phone:949-859-8335
Practice Address - Fax:949-249-1993
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7673103TC0700X
CACP7673103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP7673Medicare PIN