Provider Demographics
NPI:1518143395
Name:KADISH, LORI GAIL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:GAIL
Last Name:KADISH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MRS
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:WIRTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2284 SOUTH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-4697
Mailing Address - Country:US
Mailing Address - Phone:201-264-6798
Mailing Address - Fax:908-232-3601
Practice Address - Street 1:2284 SOUTH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-4697
Practice Address - Country:US
Practice Address - Phone:201-264-6798
Practice Address - Fax:908-232-3601
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2680103T00000X, 103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJKA662209Medicare PIN