Provider Demographics
NPI:1538353420
Name:COHEN, SALLY C (MFT)
Entity type:Individual
Prefix:MS
First Name:SALLY
Middle Name:C
Last Name:COHEN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 SHATTUCK AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-1700
Mailing Address - Country:US
Mailing Address - Phone:510-845-5617
Mailing Address - Fax:510-845-5617
Practice Address - Street 1:1708 SHATTUCK AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-1700
Practice Address - Country:US
Practice Address - Phone:510-845-5617
Practice Address - Fax:510-845-5617
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC21282101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional