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General NPI Number Information
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NPI Number | 1518349695
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Entity Type | Individual
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Provider Name | DUSTIN KAHOUD PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 06/24/2015
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Last Update Date | 08/09/2021
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Provider Practice Location Address
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Address Line | 10 GRACE AVE STE 7
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City | GREAT NECK
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State | NY
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Zip | 11021-2423
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Country | US
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Telephone | 516-479-4350
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Fax | 516-706-4448
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Provider Business Mailing Address
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Address Line | 10 GRACE AVE STE 7
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City | GREAT NECK
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State | NY
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Zip | 11021-2423
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Country | US
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Telephone | 516-479-4350
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 021201
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 021201
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License Number State | NY
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