Provider Demographics
NPI:1407514839
Name:KAGAN, MIRIAM (LCAT)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:KAGAN
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 TROUTMAN ST APT 1L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-6317
Mailing Address - Country:US
Mailing Address - Phone:201-663-3786
Mailing Address - Fax:
Practice Address - Street 1:163 TROUTMAN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-6307
Practice Address - Country:US
Practice Address - Phone:201-663-3786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002813221700000X, 221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist