Provider Demographics
NPI:1255810875
Name:COHEN, TAMAR
Entity type:Individual
Prefix:
First Name:TAMAR
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2484 SHATTUCK AVE
Mailing Address - Street 2:210
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2076
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2484 SHATTUCK AVE
Practice Address - Street 2:210
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2076
Practice Address - Country:US
Practice Address - Phone:510-704-7475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2024-10-29
Deactivation Date:2024-07-24
Deactivation Code:
Reactivation Date:2024-10-11
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CA143335106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst