Active NPI
Ghazi Kaddouh, PSY.D.
- Psychologist
- Cambridge, MA
National Provider Identifier
1902957848
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY 20407
- Practice address
- 5 Linden St
Cambridge, MA 02138-5004 - Phone
- (617) 495-2581
- Fax
- (617) 495-7680
- NPI assigned
- Jan 16, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY 20407 | CA | Primary |
Addresses
Primary practice location
5 Linden St
Cambridge, MA 02138-5004
Mailing address
5 Linden St
Cambridge, MA 02138-5004
Phone (617) 495-2581
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 20407 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1902957848",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 LINDEN ST",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "021385004",
"telephone_number": "617-495-2581",
"fax_number": "617-495-7680"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 LINDEN ST",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "021385004",
"telephone_number": "617-495-2581",
"fax_number": "617-495-7680"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KADDOUH",
"first_name": "GHAZI",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY 20407",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cambridge, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.