1710038278 NPI number — MS. KIM LESLIE COHEN LMFT

Table of content: MS. KIM LESLIE COHEN LMFT (NPI 1710038278)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710038278 NPI number — MS. KIM LESLIE COHEN LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COHEN
Provider First Name:
KIM
Provider Middle Name:
LESLIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710038278
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31 FARNHAM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06119-1317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-233-3161
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2306 BERLIN TPKE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
NEWINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06111-3204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-523-9420
Provider Business Practice Location Address Fax Number:
860-667-3369
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  001011 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001011 . This is a "LMFT LICENSE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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