Provider Demographics
NPI:1982611240
Name:COHEN, FREDERICK S (MFT)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:S
Last Name:COHEN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5743 CORSA AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-6438
Mailing Address - Country:US
Mailing Address - Phone:805-490-4990
Mailing Address - Fax:805-374-1774
Practice Address - Street 1:5743 CORSA AVE STE 103
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-6438
Practice Address - Country:US
Practice Address - Phone:805-490-4990
Practice Address - Fax:818-706-0141
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36911106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist