Provider Demographics
NPI:1538334495
Name:KAHN, ELYSSA L (PHD)
Entity type:Individual
Prefix:DR
First Name:ELYSSA
Middle Name:L
Last Name:KAHN
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 1:19 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2107
Mailing Address - Country:US
Mailing Address - Phone:908-926-2201
Mailing Address - Fax:
Practice Address - Street 1:19 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2107
Practice Address - Country:US
Practice Address - Phone:908-926-2201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4128103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist