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General NPI Number Information
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NPI Number | 1801972815
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Entity Type | Individual
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Provider Name | SUSAN CRYSTAL KOHN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 30 WARREN ST.
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City | BRIGHTON
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State | MA
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Zip | 02135
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Country | US
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Telephone | 617-254-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 11 MEADOWBROOK RD
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City | NEEDHAM
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State | MA
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Zip | 02492-1913
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Country | US
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Telephone | 781-449-4920
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 4456
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License Number State | MA
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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 | 366
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License Number State | MA
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