Healthcare Provider Details

I. General information

NPI: 1720184740
Provider Name (Legal Business Name): DEBORAH S KADISH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 HARTFORD ST
NEWTON HIGHLANDS MA
02461-1553
US

IV. Provider business mailing address

4 HARTFORD ST
NEWTON HIGHLANDS MA
02461-1553
US

V. Phone/Fax

Practice location:
  • Phone: 617-558-5223
  • Fax:
Mailing address:
  • Phone: 617-558-5223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number78828
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: