Provider Demographics
NPI:1558432625
Name:KAGEDAN, STEVEN M (EDD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:M
Last Name:KAGEDAN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 QUEEN ANNE RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4641
Mailing Address - Country:US
Mailing Address - Phone:201-928-0411
Mailing Address - Fax:201-928-0172
Practice Address - Street 1:921 QUEEN ANNE RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4641
Practice Address - Country:US
Practice Address - Phone:201-928-0411
Practice Address - Fax:201-928-0172
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011512-1103T00000X
NJ35SI00315500103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist