Provider Demographics
NPI:1467242503
Name:COHEN, CALEB ANDREW
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:ANDREW
Last Name:COHEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 S GRANT ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-7603
Mailing Address - Country:US
Mailing Address - Phone:317-438-7966
Mailing Address - Fax:
Practice Address - Street 1:350 SOUTHBRIDGE ST
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-2794
Practice Address - Country:US
Practice Address - Phone:206-414-9022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health