Provider Demographics
NPI:1700087657
Name:COHEN, CHERYL (PMHNP-BC, LMFT)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:PMHNP-BC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-1860
Mailing Address - Country:US
Mailing Address - Phone:860-969-1101
Mailing Address - Fax:
Practice Address - Street 1:330 MAIN ST # 101
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-1860
Practice Address - Country:US
Practice Address - Phone:860-614-7298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000937106H00000X
CT12443363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist