Provider Demographics
NPI:1598822314
Name:HAGEDORN, BERNHARD JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BERNHARD
Middle Name:JOHN
Last Name:HAGEDORN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 PONDFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-4811
Mailing Address - Country:US
Mailing Address - Phone:914-793-3388
Mailing Address - Fax:914-793-0094
Practice Address - Street 1:180 PONDFIELD RD
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-4811
Practice Address - Country:US
Practice Address - Phone:914-793-3388
Practice Address - Fax:914-793-0094
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000013106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist