Provider Demographics
NPI:1699804609
Name:COHEN, JOSEPH SAMUEL (PHD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:SAMUEL
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 1:420 W 24TH ST
Mailing Address - Street 2:APT. 5D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-1325
Mailing Address - Country:US
Mailing Address - Phone:646-265-3079
Mailing Address - Fax:
Practice Address - Street 1:160 BROADWAY
Practice Address - Street 2:SUITE 900 EAST
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4201
Practice Address - Country:US
Practice Address - Phone:212-252-3332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013495103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11520725OtherCAQH