Basic Information
Provider Information
NPI: 1467846725
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COHEN
FirstName: ELENA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6100 BLUE LAGOON DR
Address2: SUITE 400
City: MIAMI
State: FL
PostalCode: 331262079
CountryCode: US
TelephoneNumber: 3053986100
FaxNumber:  
Practice Location
Address1: 10720 CARIBBEAN BLVD
Address2: SUITE 420
City: CUTLER BAY
State: FL
PostalCode: 331891218
CountryCode: US
TelephoneNumber: 7862939544
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/25/2015
LastUpdateDate: 03/25/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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