Provider Demographics
NPI:1538767389
Name:COHEN, JEREMY BENTON (PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:BENTON
Last Name:COHEN
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-4790
Mailing Address - Country:US
Mailing Address - Phone:978-472-0224
Mailing Address - Fax:978-472-0224
Practice Address - Street 1:282 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-4790
Practice Address - Country:US
Practice Address - Phone:978-472-0224
Practice Address - Fax:978-472-0224
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2317234363LP0808X
CO2020168099363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health