Provider Demographics
NPI:1881767705
Name:COHEN, KEITH N (PHD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:N
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 1:449 LOWELL AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:NEWTONVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02460-2115
Mailing Address - Country:US
Mailing Address - Phone:617-527-5072
Mailing Address - Fax:
Practice Address - Street 1:805 HIGH ST
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-2539
Practice Address - Country:US
Practice Address - Phone:781-329-9115
Practice Address - Fax:781-329-9181
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3372103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW50698Medicare ID - Type Unspecified