Provider Demographics
NPI:1033209986
Name:KADUSHIN, LEWIS ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:ROBERT
Last Name:KADUSHIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 KAY AVENUE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-7121
Mailing Address - Country:US
Mailing Address - Phone:410-749-0507
Mailing Address - Fax:410-543-2638
Practice Address - Street 1:206 KAY AVENUE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-7121
Practice Address - Country:US
Practice Address - Phone:410-749-0507
Practice Address - Fax:410-543-2638
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0639103T00000X
MD639103TC0700X, 103T00000X, 103TA0700X, 103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GK14Medicare ID - Type Unspecified