Provider Demographics
NPI:1346456662
Name:KASUDA, MEDARIS ANN-MARIE (MA, CAS)
Entity Type:Individual
Prefix:MRS
First Name:MEDARIS
Middle Name:ANN-MARIE
Last Name:KASUDA
Suffix:
Gender:F
Credentials:MA, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 BENFIELD BLVD
Mailing Address - Street 2:SUITE J - FRONT
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-2540
Mailing Address - Country:US
Mailing Address - Phone:410-353-5151
Mailing Address - Fax:
Practice Address - Street 1:1110 BENFIELD BLVD
Practice Address - Street 2:SUITE J - FRONT
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-2540
Practice Address - Country:US
Practice Address - Phone:410-353-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health