Provider Demographics
NPI:1699359505
Name:COHEN, TRAVIS JAMES
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:JAMES
Last Name:COHEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 NW 46TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33127-2667
Mailing Address - Country:US
Mailing Address - Phone:786-218-7002
Mailing Address - Fax:
Practice Address - Street 1:2300 N FLORIDA MANGO RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6416
Practice Address - Country:US
Practice Address - Phone:561-296-4887
Practice Address - Fax:561-472-9939
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW156791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical