Provider Demographics
NPI:1487928628
Name:COBB, ARIES NICHELLE (PHD)
Entity type:Individual
Prefix:DR
First Name:ARIES
Middle Name:NICHELLE
Last Name:COBB
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3618 RAYMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2617
Mailing Address - Country:US
Mailing Address - Phone:216-217-0561
Mailing Address - Fax:216-848-1202
Practice Address - Street 1:3618 RAYMONT BLVD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-2617
Practice Address - Country:US
Practice Address - Phone:216-217-0561
Practice Address - Fax:216-848-1202
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36D2045034291U00000X
OH1817449103K00000X, 225CA2400X, 225CA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No291U00000XLaboratoriesClinical Medical Laboratory
No225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Practitioner
No225CA2500XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0059044Medicaid