Provider Demographics
NPI:1053477299
Name:MORGEN, KENNETH B (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:B
Last Name:MORGEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:28 ALLEGHENY AVE STE 1304
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-1379
Mailing Address - Country:US
Mailing Address - Phone:443-326-5861
Mailing Address - Fax:410-628-8900
Practice Address - Street 1:28 ALLEGHENY AVE STE 1304
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-1379
Practice Address - Country:US
Practice Address - Phone:443-326-5861
Practice Address - Fax:410-628-8900
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG619Medicare PIN