Provider Demographics
NPI:1366290728
Name:KOHL, KRISTI LYN (PSYD, NCSP)
Entity type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:LYN
Last Name:KOHL
Suffix:
Gender:F
Credentials:PSYD, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 CULVER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14622-2630
Mailing Address - Country:US
Mailing Address - Phone:585-314-1253
Mailing Address - Fax:
Practice Address - Street 1:800 FIVE MILE LINE RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2618
Practice Address - Country:US
Practice Address - Phone:585-210-0290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026435103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist