Provider Demographics
NPI:1396807913
Name:COHEN, ILENE (PHD)
Entity type:Individual
Prefix:DR
First Name:ILENE
Middle Name:
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 1:29 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-5303
Mailing Address - Country:US
Mailing Address - Phone:212-982-4780
Mailing Address - Fax:212-982-4780
Practice Address - Street 1:29 E 22ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5303
Practice Address - Country:US
Practice Address - Phone:212-982-4780
Practice Address - Fax:212-982-4780
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0077341103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
V59461Medicare PIN