Healthcare Provider Details

I. General information

NPI: 1659582567
Provider Name (Legal Business Name): EMILIE F. KUTASH PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1048 49TH ST
BROOKLYN NY
11219-2917
US

IV. Provider business mailing address

116 NORFOLK DR
EAST HAMPTON NY
11937-1423
US

V. Phone/Fax

Practice location:
  • Phone: 212-932-1735
  • Fax:
Mailing address:
  • Phone: 631-324-7573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number005838
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: