Provider Demographics
NPI:1841436821
Name:COHEN, MARIE MARGUERITE (PHD)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:MARGUERITE
Last Name:COHEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11980 SAN VICENTE BLVD.
Mailing Address - Street 2:SUITE 610
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049
Mailing Address - Country:US
Mailing Address - Phone:310-979-7845
Mailing Address - Fax:310-476-8964
Practice Address - Street 1:11980 SAN VICENTE BLVD.
Practice Address - Street 2:SUITE 610
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049
Practice Address - Country:US
Practice Address - Phone:310-979-7845
Practice Address - Fax:310-476-8964
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8175103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical