Basic Information
| Provider Information | |||||||||
| NPI: | 1437203668 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COHEN | ||||||||
| FirstName: | DIANE | ||||||||
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| Credential: | PH.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34 FAIRVIEW ST | ||||||||
| Address2: | APT. C3 | ||||||||
| City: | WEST HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061191807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609306793 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 587 MIDDLE TPKE E | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060403731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606463888 | ||||||||
| FaxNumber: | 8606454132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 002757 | CT | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.