Provider Demographics
NPI:1952309296
Name:CENTER FOR PSYCHOLOGY, PA
Entity Type:Organization
Organization Name:CENTER FOR PSYCHOLOGY, PA
Other - Org Name:CENTER FOR PSYCHOLOGY, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:239-278-3443
Mailing Address - Street 1:12499 BRANTLEY COMMONS CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-5676
Mailing Address - Country:US
Mailing Address - Phone:239-278-3443
Mailing Address - Fax:239-278-3550
Practice Address - Street 1:12499 BRANTLEY COMMONS CT
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5676
Practice Address - Country:US
Practice Address - Phone:239-278-3443
Practice Address - Fax:239-278-3550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003794103G00000X
FLPY3794103TC0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A2428ZMedicare PIN
24406Medicare PIN
E7719ZMedicare PIN
FL75971YMedicare PIN