Provider Demographics
NPI:1720056419
Name:COHEN, JUDITH RUTH (PHD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:RUTH
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 1:1350 N LAKE SHORE DR
Mailing Address - Street 2:APARTMENT 2017
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-5267
Mailing Address - Country:US
Mailing Address - Phone:312-932-9006
Mailing Address - Fax:
Practice Address - Street 1:6041 1/2 N CICERO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4301
Practice Address - Country:US
Practice Address - Phone:773-539-3509
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01627272OtherBLUE CROSS/BLUE SHIELD
IL7313430OtherAETNA