Provider Demographics
NPI:1275041584
Name:COHEN, JASMINE ELISHA (RBT)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:ELISHA
Last Name:COHEN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9839 LUNA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-2755
Mailing Address - Country:US
Mailing Address - Phone:314-315-7634
Mailing Address - Fax:
Practice Address - Street 1:7049 PERSHING AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-4319
Practice Address - Country:US
Practice Address - Phone:314-240-2031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-21
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician