Provider Demographics
NPI:1619028537
Name:HUSHION, KATHLEEN R (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:R
Last Name:HUSHION
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CHIMAY CT
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-1904
Mailing Address - Country:US
Mailing Address - Phone:212-799-0962
Mailing Address - Fax:
Practice Address - Street 1:2 CHIMAY CT
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-1904
Practice Address - Country:US
Practice Address - Phone:917-671-7951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR030140103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN74542Medicare ID - Type Unspecified