Provider Demographics
NPI:1174892426
Name:COHEN, LISA HINDA (LADC, MS)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:HINDA
Last Name:COHEN
Suffix:
Gender:F
Credentials:LADC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 OLD RIDGEBURY RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5128
Mailing Address - Country:US
Mailing Address - Phone:203-792-4515
Mailing Address - Fax:203-748-2632
Practice Address - Street 1:38 OLD RIDGEBURY RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5128
Practice Address - Country:US
Practice Address - Phone:203-792-4515
Practice Address - Fax:203-748-2632
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000350101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004123840Medicaid
CT008031626Medicaid
CT008017939Medicaid
CT004257516Medicaid
CT1174607253OtherMCCA NPI