Provider Demographics
NPI:1659746055
Name:DLK PSYD PSYCHOLOGIST
Entity Type:Organization
Organization Name:DLK PSYD PSYCHOLOGIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHOUD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:516-479-4350
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021201251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health