Iris R Cohen, CASAC
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · E Yaphank, NY
NPI 1164542387 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1164542387
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 6621 (NY)
- Practice address
- 1490 William Floyd Pkwy
E Yaphank, NY 11967-1820 - Phone
- (631) 924-3741
- Fax
- (631) 924-2413
- NPI assigned
- Mar 30, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6621 | NY | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 6621 | NY | Yes |
Addresses
Primary practice location
1490 William Floyd Pkwy
E Yaphank, NY 11967-1820
Mailing address
790 Park Ave
Huntington, NY 11743
Phone (631) 427-3700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00659412 | Medicaid | NY |
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.