Provider Demographics
NPI:1215926738
Name:COHEN, RICHARD W (PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:W
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 1:806 RIDGE TER
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2430
Mailing Address - Country:US
Mailing Address - Phone:847-328-5022
Mailing Address - Fax:847-328-5022
Practice Address - Street 1:806 RIDGE TER
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-2430
Practice Address - Country:US
Practice Address - Phone:847-328-5022
Practice Address - Fax:847-328-5022
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-000621103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04972024OtherBLUE CROSS
ILL010828OtherCHAMPUS
IL905520OtherMEDICARE ID
ILR20954Medicare UPIN