Provider Demographics
NPI:1578789715
Name:KOHOUT, JUDITH A (DC, CASAC)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:A
Last Name:KOHOUT
Suffix:
Gender:F
Credentials:DC, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:SUGAR LOAF
Mailing Address - State:NY
Mailing Address - Zip Code:10981-0128
Mailing Address - Country:US
Mailing Address - Phone:845-774-5403
Mailing Address - Fax:
Practice Address - Street 1:54 PINE HILL RD
Practice Address - Street 2:
Practice Address - City:SUGAR LOAF
Practice Address - State:NY
Practice Address - Zip Code:10981
Practice Address - Country:US
Practice Address - Phone:845-774-5403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004564111N00000X
NY27116101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX25321Medicare ID - Type Unspecified