Provider Demographics
NPI:1275843112
Name:KAHN, ANDREW R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:R
Last Name:KAHN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 MOUNT HOPE AVE
Mailing Address - Street 2:SUITE 680 EVERGREEN WOODS
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5691
Mailing Address - Country:US
Mailing Address - Phone:207-942-9305
Mailing Address - Fax:207-990-3954
Practice Address - Street 1:700 MOUNT HOPE AVE
Practice Address - Street 2:SUITE 680 EVERGREEN WOODS
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5691
Practice Address - Country:US
Practice Address - Phone:207-942-9305
Practice Address - Fax:207-990-3954
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1036103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent