Provider Demographics
NPI:1801972815
Name:KOHN, SUSAN CRYSTAL (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:CRYSTAL
Last Name:KOHN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MEADOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-1913
Mailing Address - Country:US
Mailing Address - Phone:781-449-4920
Mailing Address - Fax:
Practice Address - Street 1:30 WARREN ST.
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135
Practice Address - Country:US
Practice Address - Phone:617-254-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4456103T00000X
MA366103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA366OtherEDUCATIONAL PSYCHOLOGIST
MA4456OtherLICENSED PSYCHOLOGY PROVI