Provider Demographics
NPI:1427604859
Name:KAHN, LISA JODY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JODY
Last Name:KAHN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MICHAEL DR STE 105
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-5311
Mailing Address - Country:US
Mailing Address - Phone:516-350-3975
Mailing Address - Fax:
Practice Address - Street 1:6800 JERICHO TPKE
Practice Address - Street 2:SUITE120W
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-1179
Practice Address - Country:US
Practice Address - Phone:516-350-3975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical