Provider Demographics
NPI:1770782476
Name:LOPEZ-COHEN, GWENDOLYN LIZETTE (MD)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:LIZETTE
Last Name:LOPEZ-COHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:64 POST RD W
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-4208
Mailing Address - Country:US
Mailing Address - Phone:203-226-2360
Mailing Address - Fax:203-286-1670
Practice Address - Street 1:64 POST RD W
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4208
Practice Address - Country:US
Practice Address - Phone:203-226-2360
Practice Address - Fax:203-286-1670
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2391162084P0804X
CT0471602084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry