Provider Demographics
NPI:1659582567
Name:KUTASH, EMILIE F (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EMILIE
Middle Name:F
Last Name:KUTASH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 NORFOLK DR
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937-1423
Mailing Address - Country:US
Mailing Address - Phone:631-324-7573
Mailing Address - Fax:
Practice Address - Street 1:1048 49TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2917
Practice Address - Country:US
Practice Address - Phone:212-932-1735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005838103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V68151Medicare ID - Type Unspecified