Provider Demographics
NPI:1679798169
Name:COHN, ODETTE (PHD)
Entity type:Individual
Prefix:DR
First Name:ODETTE
Middle Name:
Last Name:COHN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SYLVAN ST
Mailing Address - Street 2:SUITE 103A
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2037
Mailing Address - Country:US
Mailing Address - Phone:201-804-2575
Mailing Address - Fax:201-797-5281
Practice Address - Street 1:17 SYLVAN ST
Practice Address - Street 2:SUITE 103A
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2037
Practice Address - Country:US
Practice Address - Phone:201-804-2575
Practice Address - Fax:201-797-5281
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3385103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ882966Medicare ID - Type Unspecified