Provider Demographics
NPI:1952782898
Name:B. BETH COHEN, PH.D., LICENSED PSYCHOLOGIST, PLLC
Entity type:Organization
Organization Name:B. BETH COHEN, PH.D., LICENSED PSYCHOLOGIST, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:607-319-5778
Mailing Address - Street 1:118 N TIOGA ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-4354
Mailing Address - Country:US
Mailing Address - Phone:607-319-5778
Mailing Address - Fax:607-319-5779
Practice Address - Street 1:118 N TIOGA ST
Practice Address - Street 2:SUITE 401
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4354
Practice Address - Country:US
Practice Address - Phone:607-319-5778
Practice Address - Fax:607-319-5779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015622-1261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)