Provider Demographics
NPI:1720322746
Name:COHEN, LISA RENAE (MA, ATR-BC, LMHC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:RENAE
Last Name:COHEN
Suffix:
Gender:F
Credentials:MA, ATR-BC, LMHC
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 23283
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33307-3283
Mailing Address - Country:US
Mailing Address - Phone:786-505-8406
Mailing Address - Fax:
Practice Address - Street 1:2709 E COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4112
Practice Address - Country:US
Practice Address - Phone:786-505-8406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60319722101YM0800X
FLPMH 1170101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health