Provider Demographics
NPI:1811063605
Name:COHEN, JEFFREY STEVEN (PHD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:STEVEN
Last Name:COHEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 SUMMER ST
Mailing Address - Street 2:1-A
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-1024
Mailing Address - Country:US
Mailing Address - Phone:203-325-9346
Mailing Address - Fax:203-325-1801
Practice Address - Street 1:833 SUMMER ST
Practice Address - Street 2:1-A
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-1024
Practice Address - Country:US
Practice Address - Phone:203-325-9346
Practice Address - Fax:203-325-1801
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-26
Last Update Date:2014-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001030103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT620000265Medicare ID - Type Unspecified