Provider Demographics
NPI:1992847156
Name:SHIDLOV-COHEN, DIKLA R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DIKLA
Middle Name:R
Last Name:SHIDLOV-COHEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3775 BEACON AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1465
Mailing Address - Country:US
Mailing Address - Phone:510-792-4964
Mailing Address - Fax:510-792-4928
Practice Address - Street 1:3775 BEACON AVE FL 2
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1465
Practice Address - Country:US
Practice Address - Phone:510-792-4964
Practice Address - Fax:510-792-4928
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21323103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist