Provider Demographics
NPI:1962610097
Name:MICHAEL COCHRAN
Entity type:Organization
Organization Name:MICHAEL COCHRAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:518-524-4955
Mailing Address - Street 1:96 CLINTON AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-2066
Mailing Address - Country:US
Mailing Address - Phone:518-524-4955
Mailing Address - Fax:
Practice Address - Street 1:96 CLINTON AVE APT 2
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-2066
Practice Address - Country:US
Practice Address - Phone:518-524-4955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01783742Medicaid