Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 016889 | NY |
NPI | 1013018589 |
---|---|
Provider Name | Dr. Samantha Wesley Kohn |
First Address | Campbell Hall, NY 10916-2306 |
Second Address | Middletown, NY 10941-1448 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 08/07/2007 |