Provider Demographics
NPI:1043928377
Name:COHEN, SHOSHANA RAIZEL (BCBA)
Entity type:Individual
Prefix:
First Name:SHOSHANA
Middle Name:RAIZEL
Last Name:COHEN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:
Other - Last Name:ZUTLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA
Mailing Address - Street 1:845 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3038
Mailing Address - Country:US
Mailing Address - Phone:732-901-0018
Mailing Address - Fax:
Practice Address - Street 1:30 FLANNERY AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4750
Practice Address - Country:US
Practice Address - Phone:917-589-0036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-22-60981103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst