Provider Demographics
NPI:1134540495
Name:SUSAN M. COHEN, PSY.D. LLC
Entity type:Organization
Organization Name:SUSAN M. COHEN, PSY.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-262-5335
Mailing Address - Street 1:577 PAMAELE ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3529
Mailing Address - Country:US
Mailing Address - Phone:808-262-5335
Mailing Address - Fax:808-230-2132
Practice Address - Street 1:577 PAMAELE ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-3529
Practice Address - Country:US
Practice Address - Phone:808-262-5335
Practice Address - Fax:808-230-2132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY742103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI5366790Medicaid