Provider Demographics
NPI:1447340369
Name:COHEN, STEVEN (PSYD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
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 1:12499 BRANTLEY COMMONS CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-5676
Mailing Address - Country:US
Mailing Address - Phone:239-278-3443
Mailing Address - Fax:239-278-3550
Practice Address - Street 1:12499 BRANTLEY COMMONS CT
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5676
Practice Address - Country:US
Practice Address - Phone:239-278-3443
Practice Address - Fax:239-278-3550
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7187103T00000X, 103TC2200X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75321Medicare UPIN