Provider Demographics
NPI:1053408088
Name:CABUSH, DIANE LYNN (PSYD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:LYNN
Last Name:CABUSH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:LYNN
Other - Last Name:GABRIELSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:32 MAPLE AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-5217
Mailing Address - Country:US
Mailing Address - Phone:973-539-7055
Mailing Address - Fax:973-267-5278
Practice Address - Street 1:32 MAPLE AVE FL 2
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-5217
Practice Address - Country:US
Practice Address - Phone:973-539-7055
Practice Address - Fax:973-267-5278
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00289100103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJCA522221Medicare ID - Type UnspecifiedPSYCHOLOGIST