Provider Demographics
NPI:1720184740
Name:KADISH, DEBORAH S (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:S
Last Name:KADISH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HARTFORD ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON HIGHLANDS
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1553
Mailing Address - Country:US
Mailing Address - Phone:617-558-5223
Mailing Address - Fax:
Practice Address - Street 1:4 HARTFORD ST
Practice Address - Street 2:
Practice Address - City:NEWTON HIGHLANDS
Practice Address - State:MA
Practice Address - Zip Code:02461-1553
Practice Address - Country:US
Practice Address - Phone:617-558-5223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA788282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA402708OtherTUFTS
MAJ23424OtherBCBS
MANNO 097750OtherUNITED BEHAVIORAL HEALTH