Provider Demographics
NPI:1194022293
Name:KAHN, PAUL WYANT (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:WYANT
Last Name:KAHN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 E 61ST ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4116
Mailing Address - Country:US
Mailing Address - Phone:201-616-9263
Mailing Address - Fax:315-750-3205
Practice Address - Street 1:18 E 61ST ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4116
Practice Address - Country:US
Practice Address - Phone:201-616-9263
Practice Address - Fax:315-750-3205
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-25
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-171121041C0700X
NYR0799761041C0700X
GACSW0076581041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03954414Medicaid
NYA300160109OtherMEDICARE ID
GAP02642655OtherRAILROAD MEDICARE
GAQ133960281OtherMEDICARE
AZZ216197OtherMEDICARE ID
AZ451183Medicaid
AZZ216197OtherMEDICARE