Provider Demographics
NPI:1013018589
Name:KOHN, SAMANTHA WESLEY (PHD)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:WESLEY
Last Name:KOHN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11 TRAILS POINT DR
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL HALL
Mailing Address - State:NY
Mailing Address - Zip Code:10916-2306
Mailing Address - Country:US
Mailing Address - Phone:845-294-9469
Mailing Address - Fax:845-294-9469
Practice Address - Street 1:3136 ROUTE 207
Practice Address - Street 2:SUITE 107
Practice Address - City:CAMPBELL HALL
Practice Address - State:NY
Practice Address - Zip Code:10916
Practice Address - Country:US
Practice Address - Phone:845-283-2544
Practice Address - Fax:845-360-5834
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016889103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02812260Medicaid