Provider Demographics
NPI:1992924773
Name:COHEN, HASKEL (PSYD)
Entity type:Individual
Prefix:
First Name:HASKEL
Middle Name:
Last Name:COHEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1806
Mailing Address - Country:US
Mailing Address - Phone:617-965-1320
Mailing Address - Fax:781-235-7176
Practice Address - Street 1:59 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1806
Practice Address - Country:US
Practice Address - Phone:617-965-1320
Practice Address - Fax:781-235-7176
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA444103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW01064OtherBLUE CROSS BLUE SHIELD