Provider Demographics
NPI:1053434290
Name:COHEN, LAWRENCE JACK (PHD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JACK
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 1:175 WINTHROP RD
Mailing Address - Street 2:#3
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-0244
Mailing Address - Country:US
Mailing Address - Phone:617-713-0568
Mailing Address - Fax:
Practice Address - Street 1:175 WINTHROP RD
Practice Address - Street 2:#3
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-4642
Practice Address - Country:US
Practice Address - Phone:617-713-0568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7398103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical