Provider Demographics
NPI:1588879365
Name:COHEN, STEWART LESLIE (LAC)
Entity type:Individual
Prefix:
First Name:STEWART
Middle Name:LESLIE
Last Name:COHEN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 KENNEDY DR STE U7
Mailing Address - Street 2:
Mailing Address - City:S BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7166
Mailing Address - Country:US
Mailing Address - Phone:802-862-2273
Mailing Address - Fax:
Practice Address - Street 1:1 KENNEDY DR STE U7
Practice Address - Street 2:
Practice Address - City:S BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7166
Practice Address - Country:US
Practice Address - Phone:802-862-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT091-0000013171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist