Provider Demographics
NPI:1730479031
Name:KOHUT, MICHELLE S (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:S
Last Name:KOHUT
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:PO BOX 95000
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-4655
Mailing Address - Country:US
Mailing Address - Phone:800-888-6020
Mailing Address - Fax:845-256-1881
Practice Address - Street 1:2590 FRISBY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3240
Practice Address - Country:US
Practice Address - Phone:718-239-1610
Practice Address - Fax:718-792-7053
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0702411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical