Individual
DR. JONATHAN D COHEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
282 EAST DUVAL STREET, LAKE CITY, FL 32055
(386) 288-4734
(866) 472-1489
Mailing address
394 SW STORY PLACE, LAKE CITY, FL 32024
(386) 288-4734
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY6711
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AI172
MEDICARE PTAN
FL
Enumeration date
05/07/2007
Last updated
09/17/2024
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