Provider Demographics
NPI:1104037670
Name:KADUSHIN, FREDERICK SCOTT (PHD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:SCOTT
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 1:84 ELLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-1430
Mailing Address - Country:US
Mailing Address - Phone:413-567-2008
Mailing Address - Fax:413-451-0020
Practice Address - Street 1:136 DWIGHT RD
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1759
Practice Address - Country:US
Practice Address - Phone:413-567-2008
Practice Address - Fax:413-451-0020
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5067103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist