Provider Demographics
NPI:1871733071
Name:COHEN, DEBORAH ELLEN (MFT)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ELLEN
Last Name:COHEN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:E
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:621 4TH ST STE 5
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4151
Mailing Address - Country:US
Mailing Address - Phone:916-491-1216
Mailing Address - Fax:
Practice Address - Street 1:621 4TH ST STE 5
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4151
Practice Address - Country:US
Practice Address - Phone:916-491-1216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36373106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist