Basic Information
| Provider Information | |||||||||
| NPI: | 1801972815 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOHN | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | CRYSTAL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11 MEADOWBROOK RD | ||||||||
| Address2: | |||||||||
| City: | NEEDHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024921913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814494920 | ||||||||
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| Practice Location | |||||||||
| Address1: | 30 WARREN ST. | ||||||||
| Address2: | |||||||||
| City: | BRIGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172543800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 4456 | MA | N | Behavioral Health & Social Service Providers | Psychologist | 103T00000X | 366 | MA | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 366 | 01 | MA | EDUCATIONAL PSYCHOLOGIST | OTHER | 4456 | 01 | MA | LICENSED PSYCHOLOGY PROVI | OTHER |