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General NPI Number Information
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NPI Number | 1962149294
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Entity Type | Individual
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Provider Name | AVI YEHUDA KOHN
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Gender | Male
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Dates
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Enumeration Date | 05/18/2022
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Last Update Date | 05/18/2022
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Provider Practice Location Address
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Address Line | 6555 W MAPLE RD
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-4926
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Country | US
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Telephone | 248-592-2313
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Fax |
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Provider Business Mailing Address
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Address Line | 15677 JEANETTE ST
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City | SOUTHFIELD
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State | MI
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Zip | 48075-6002
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Country | US
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Telephone | 248-763-1051
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6851114086
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License Number State | MI
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