Provider Demographics
NPI:1518349695
Name:KAHOUD, DUSTIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:
Last Name:KAHOUD
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 1:10 GRACE AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2423
Mailing Address - Country:US
Mailing Address - Phone:516-479-4350
Mailing Address - Fax:
Practice Address - Street 1:10 GRACE AVE STE 7
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2423
Practice Address - Country:US
Practice Address - Phone:516-479-4350
Practice Address - Fax:516-706-4448
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-24
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021201103TC0700X, 103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1659746055OtherNPI