Healthcare Provider Details

I. General information

NPI: 1326325648
Provider Name (Legal Business Name): JASON KEITH KAHN LCSW-R
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2011
Last Update Date: 07/24/2023
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 N MILL ST STE 105
NYACK NY
10960-3015
US

IV. Provider business mailing address

9 N MILL ST STE 105
NYACK NY
10960-3015
US

V. Phone/Fax

Practice location:
  • Phone: 845-729-4220
  • Fax:
Mailing address:
  • Phone: 845-729-4220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR070474-01
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: