Provider Demographics
NPI:1528513637
Name:COHEN, LAINIE
Entity type:Individual
Prefix:
First Name:LAINIE
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 639561
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-9561
Mailing Address - Country:US
Mailing Address - Phone:844-247-7222
Mailing Address - Fax:847-584-2604
Practice Address - Street 1:2762 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2425
Practice Address - Country:US
Practice Address - Phone:844-247-7222
Practice Address - Fax:215-489-8766
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-17-28302103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA042611055OtherTAX ID
MA1004745OtherNHP
MA0000023532OtherBMC
MA1004745OtherFALLON
MA99618201OtherNETWORK HEALTH
MAM18633OtherBCBS
MA1303287OtherMBHP