Provider Demographics
NPI:1871575308
Name:COHEN CARLSON, DIANE J (PHD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:J
Last Name:COHEN CARLSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5625 COLLEGE AVE STE 210C
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1677
Mailing Address - Country:US
Mailing Address - Phone:510-653-1464
Mailing Address - Fax:510-547-0174
Practice Address - Street 1:5625 COLLEGE AVE STE 210C
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1677
Practice Address - Country:US
Practice Address - Phone:510-653-1464
Practice Address - Fax:510-547-0174
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13662103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical