Provider Demographics
NPI:1356771083
Name:COHEN-SAPERSTEIN, ELIJAH AMIR (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELIJAH
Middle Name:AMIR
Last Name:COHEN-SAPERSTEIN
Suffix:
Gender:M
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:PO BOX 120951
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92112-0951
Mailing Address - Country:US
Mailing Address - Phone:917-981-0503
Mailing Address - Fax:
Practice Address - Street 1:850 BEECH STREET
Practice Address - Street 2:SUITE 2203
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101
Practice Address - Country:US
Practice Address - Phone:917-981-0503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-15
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 1041C0700X
IL-2013399103TP0814X
ZZIL-2013399103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC100001010OtherUNITED STATES DEPARTMENT OF STATE
DC100001010OtherUNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES
DC100001010OtherUNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES
DCIL-2013399OtherISRAELI GOVERNMENT