Provider Demographics
NPI:1861406167
Name:KOHUTIS, EILEEN A (PH D)
Entity type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:A
Last Name:KOHUTIS
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W NORTHFIELD RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-3789
Mailing Address - Country:US
Mailing Address - Phone:973-716-0174
Mailing Address - Fax:973-716-0730
Practice Address - Street 1:2 W NORTHFIELD RD
Practice Address - Street 2:SUITE 209
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-3789
Practice Address - Country:US
Practice Address - Phone:973-716-0174
Practice Address - Fax:973-716-0730
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00262300103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist