Provider Demographics
NPI:1013138858
Name:COHEN, AVITAL (MFCC)
Entity Type:Individual
Prefix:MRS
First Name:AVITAL
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:MFCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 SOUTH HOLT AVENUE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1807
Mailing Address - Country:US
Mailing Address - Phone:310-659-8111
Mailing Address - Fax:310-659-7350
Practice Address - Street 1:291 SOUTH LA CIENEGA BLVD.
Practice Address - Street 2:SUITE 309
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3325
Practice Address - Country:US
Practice Address - Phone:310-926-7994
Practice Address - Fax:310-659-7350
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM15817106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist