Provider Demographics
NPI:1639970593
Name:COHEN, MALLORY TALYA (LPC)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:TALYA
Last Name:COHEN
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 W VALLEY CIR
Mailing Address - Street 2:
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-1860
Mailing Address - Country:US
Mailing Address - Phone:508-404-3949
Mailing Address - Fax:
Practice Address - Street 1:801 OLD YORK RD STE 301
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-1611
Practice Address - Country:US
Practice Address - Phone:406-361-3146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC018196101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional