Provider Demographics
NPI:1134140783
Name:KUSHNER, GARY JEFFREY (EDD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:JEFFREY
Last Name:KUSHNER
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:BELLMAWR
Mailing Address - State:NJ
Mailing Address - Zip Code:08031-1114
Mailing Address - Country:US
Mailing Address - Phone:856-424-6966
Mailing Address - Fax:
Practice Address - Street 1:147 CARDINAL DR
Practice Address - Street 2:
Practice Address - City:BELLMAWR
Practice Address - State:NJ
Practice Address - Zip Code:08031-1114
Practice Address - Country:US
Practice Address - Phone:856-424-6966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00213400103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist