Provider Demographics
NPI:1528111804
Name:COHEN, DONALD DALE (MSW, PHD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:DALE
Last Name:COHEN
Suffix:
Gender:M
Credentials:MSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 SW 10TH AVE
Mailing Address - Street 2:STE 604
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2707
Mailing Address - Country:US
Mailing Address - Phone:503-281-9232
Mailing Address - Fax:503-234-7166
Practice Address - Street 1:511 SW 10TH AVE STE 604
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2707
Practice Address - Country:US
Practice Address - Phone:503-238-5557
Practice Address - Fax:503-234-7166
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1059103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling