Provider Demographics
NPI:1124690110
Name:KOHAUT, KAREN MICHELLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:MICHELLE
Last Name:KOHAUT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LINKS WAY
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3742
Mailing Address - Country:US
Mailing Address - Phone:609-364-2664
Mailing Address - Fax:
Practice Address - Street 1:101 SULLIVAN WAY
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628-3425
Practice Address - Country:US
Practice Address - Phone:609-633-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-11
Last Update Date:2021-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00592300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical