Provider Demographics
NPI:1871837237
Name:KOHUT, MATTHEW MICHAEL (LCSW)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:MICHAEL
Last Name:KOHUT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 BROADWAY
Mailing Address - Street 2:STE 1308
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-7903
Mailing Address - Country:US
Mailing Address - Phone:415-317-5824
Mailing Address - Fax:646-692-3240
Practice Address - Street 1:1133 BROADWAY
Practice Address - Street 2:STE 1308
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7903
Practice Address - Country:US
Practice Address - Phone:415-317-5824
Practice Address - Fax:646-692-3240
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-24
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083730-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical