Provider Demographics
NPI:1801909676
Name:COHEN, STUART M (PHD)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:M
Last Name:COHEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10410 PARK RD
Mailing Address - Street 2:STE 500 C
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210
Mailing Address - Country:US
Mailing Address - Phone:704-541-1700
Mailing Address - Fax:407-845-1885
Practice Address - Street 1:10410 PARK RD
Practice Address - Street 2:STE 500 C
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210
Practice Address - Country:US
Practice Address - Phone:704-541-1700
Practice Address - Fax:407-845-1885
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1356103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist